The Assembly met at 12 noon (Speaker [Mr Mitchel McLaughlin] in the Chair).
Members observed two minutes' silence.

Matter of the Day

Paris Attacks

Mr Speaker: Mr Mike Nesbitt has given notice and been given leave to make a statement on the attacks in Paris, which fulfils the criteria set out in Standing Order 24.  If other Members wish to be called, they should indicate by rising in their place and continuing to do so.  All Members who are called will have up to three minutes to speak on the subject.  I remind Members that I will not take any points of order on this or any other matter until the item of business is finished.

Mike Nesbitt: I rise because, not for the first time, Paris, its natives and its tourists have been subjected to a most vicious and vile terrorist attack by religious extremists.  To date, 132 are dead.  Hundreds more are injured, many fighting for their life.  Why?  Because they ended the traditional working week in a bar or a restaurant or by attending a concert.  It is hard to accept that, in 2015, such a simple act as shopping or socialising should represent an existential threat to life, but that is the grim reality of terrorism.
The House must take a firm stand against those terrorists, who, of course, are not just attacking Paris or France but represent a threat to the Western World and beyond.  We must also demand a robust response.  The Prime Minister has told us that, here in the United Kingdom, the threat is severe, and he revealed today that the security forces have prevented no fewer than seven planned attacks in the United Kingdom this year.
We must also remember who the enemy are.  We must not paint everybody with the same brush.  No Member of this Assembly should be held responsible if a high school in the United States is shot up by a white Christian just because we share the same colour of skin and the same religious affiliation.  The enemy are the extremists, and any security policy must make that very firm distinction.
Today, we should focus on the human cost of the inhumanity of the perpetrators.  On behalf of the Ulster Unionist Party, I extend my deepest sympathies to the families of the deceased and the injured, to President François Hollande and to the people of France.  We stand together with them in defiance of those who have attacked our way of life.
In concentrating on the human cost, I finish with a quote from a restaurant worker in the wake of the attack.  He said:
"One woman had been shot with several Kalashnikov bullets in her side, and she had a huge hole there, an open wound.  There was nothing anybody could do.  She was only about 20 years old.  I knelt down and talked to her. I told her not to move and to take deep breaths.  She didn't complain at all, or even say anything.  She was just looking up at me and her eyes faded away.  I will remember her face and her eyes all my life."

Peter Robinson: Mr Speaker, thank you for the opportunity to join in expressing our revulsion and horror at the evil bloodbath in Paris on Friday evening, and for organising the minute's act of remembrance in the Great Hall this morning.  We, in equal measure, send out our sympathy and support to the people of France.  We, from our experiences, can truly empathise with them.
This was not an attack against a military or government target.  The gunmen were not engaging their enemies in open warfare, nor were they locked in conflict with an army that they opposed.  This was an attack upon innocent, defenceless and harmless citizens.  It comprised coordinated assaults upon a concert hall, a football stadium, bars and restaurants.  These were attacks on people who were out relaxing and were enjoying an evening socialising or at sporting or entertainment events.  It is hard to think of less threatening or less hostile targets.
Those of my vintage will vividly remember from our country's dark past all the emotions felt last Friday by the population of Paris:  the desolation, the anxiety for friends and relatives who were in the area of the attacks, the grieving for victims and the apprehension for the future.  They will know for sure that life will never be the same.  The scale and the merciless savagery of the carnage will make these killings stand out, but, for all the victims and survivors of terror, every act over the decades leaves a life-changing impact.
On behalf of the people of Northern Ireland, we mourn with the families of the Paris victims and pray for the recovery of the many who are critically injured and scarred.  From this Chamber, we extend our condolences to the citizens of Paris and the people of France.  As they mourn, we stand with them in solidarity.

Máirtín Ó Muilleoir: Go raibh maith agat, a Cheann Comhairle.  On Friday night, like other Members, I followed the terrible events in Paris by social media, radio and TV, but I also had a running commentary because my daughter was down the street from Le Petit Cambodge, which was the first restaurant that was attacked.
I thank those who gave her and her group shelter that night close to the restaurant.  In the hours since then, she has told me about the atmosphere in Paris; about how frightened people are, but also how resolute they are.  In her boyfriend's circle, one young man was killed in the Bataclan concert hall, and, in her place of work, one friend has a close friend still missing.  That is the horror that brings us here today in solidarity with Paris.
I will start en français:  nous sommes solidaires du peuple parisien en ce moment terribles.  Nous exprimons notre plus grande compassion à tous les citoyens de cette ville blessée.  Geallaimid comhghuaillíocht le muintir Pháras ag an am chorrach seo, agus déanaimid comhbhrón ó chroí le muintir na cathrach cráite sin.  We pledge our solidarity to the people of Paris at this terrible time.  We extend deepest sympathy from across our community to the victims and survivors of Friday night's horror.  We send our love and respect to the people of the wounded city of Paris, with which we enjoy close ties of history, heritage, commerce and community.  Our thoughts this morning are with all victims of the global wars that engulf us today.  Of course, the civilian populations suffer the most in those wars and are the most frightened, as we saw clearly in not only Paris but Beirut at the weekend.  We stand, therefore, with the people of Paris in their message to the assailants who carried out Friday night's horrific attacks.  We use the words of the famous civil rights song:  Nous n'avons pas peur.  Níl eagla orainn.  We are not afraid.

Colum Eastwood: On behalf of the SDLP, I express our sincere sympathy and solidarity with the people of Paris following the devastating scenes that unfolded on the streets of the city over the weekend.  As our party members gathered in Armagh, we were acutely aware of the tragedy that was taking place in the French capital.  It cast a shadow over our proceedings.
I also express our profound sadness following the suspected ISIS bombing of a busy Beirut marketplace that killed over 40 innocent people.  These attacks, no matter where they happen, the scale of the destruction or the culprit, are an attack on all of us who value the primacy and power of peace.  As a people and as an island, we acutely understand the suffering of the people of France and Lebanon.  We know what it is like to face the threat of terror and violence, and to face down those who seek to murder and maim their way to political goals.  Today, we stand in solidarity with the founding principles of the French republic:  the liberty to live our lives free from the threat of violence; the equality of all peoples, regardless of colour or creed; and a fraternal bond between all peoples and all parties committed to the power of peace as a tool for change.  We are all united in the Chamber, across these islands and across Europe against those who seek to shake the foundations of our peace.  Let that spirit of unity be the message that we send to them.  It says more than anything else we could do.

David Ford: On behalf of my colleagues, I associate ourselves with remarks already made in the Chamber.  I thank you, Mr Speaker, for your initiative earlier today in arranging the opportunity for not just Members but staff and visitors to show their solidarity to the people of Paris and France in the wake of the multiple atrocities that happened last Friday evening.  Of course, as has just been said, we should not forget the similar atrocity that happened in Beirut, the ongoing challenge posed by the atrocities being perpetrated daily in Iraq and Syria by ISIS, and similar actions that happened in relatively recent times across the Middle East and north Africa, particularly in Kenya and Nigeria.
France is one of our closest neighbours geographically.  It is a partner and has been an ally.  It is a business partner, a partner in times of difficulty and a partner in terms of where many of us first had our opportunities to experience life in a different culture.  So it is felt particularly sensitively by people throughout these islands when they see the atrocities that happened in Paris — somewhere that people can associate with holidays and times of great pleasure for themselves.
It is one of the ironies of this weekend that, in 1940, and, indeed, again in 1944, Paris was declared an open city, so that not only the architecture but the people were left undisturbed in the opening and closing phases of the Second World War.  It is a further irony that a friendly football match was being played in the Stade de France between France and Germany.  That is an indication of where we in Europe have moved on in recent years, but where there clearly are challenges from those who do not accept the fundamental principles of human life and welfare that we do.  Friday was a direct attack, not on any perceived justifiable target, not even in the twisted sense that would have justified the attack on 'Charlie Hebdo' earlier this year, but on ordinary people — Parisians, others from throughout France, visitors — engaging in what people throughout Europe engage in on a Friday night, the opportunity to go out with friends and enjoy themselves with whatever entertainment they wish.  That is why it has so devastated so many people; that is why it has affected people so strongly in what that meant.  That is the reason why we must ensure that we do not have just words but that we stand together in practical solidarity with our French neighbours, whatever language we speak and whatever way we express it.  Whether it is in French, German, English or Irish, the message has to be of solidarity in the face of those who would carry out such terror, and a unity of purpose that we will protect human life and human dignity, wherever the threat comes from.

Jim Allister: I join in the sentiments of shock, dismay, empathy and deep sympathy with the people of Paris and France at this time.  We in this Province, of all places, know the horrors of terrorism.  The scale of the slaughter in Paris, I think, causes us to struggle with the question of how any human being could do such things.  It is a question that had to be asked in this Province as well, because the uncomfortable truth is that the unmitigated evil that manifested itself in a theatre in Paris was the same unmitigated evil that lined innocent workmen up against their van in Kingsmills and riddled them to death; the unmitigated evil that launched an attack on a restaurant in Paris was the same unmitigated evil that attacked a pub in Greysteel or in Loughinisland; and the unmitigated evil that launched bombs to kill was the same unmitigated evil that we experienced in La Mon and, yes, even in the most sacred of places, a remembrance service in Enniskillen.  Terrorists — all terrorists — are evil and remain evil.  There are no good terrorists, even in retrospect.  I trust that the people of France will have the resolve and determination to ensure that they will not pander to terrorists or fete them in any way, such as happened in this country.
Another uncomfortable truth is that the open borders of Europe, sadly, have the appearance of supplying a supply line to the fifth column in Europe that would destroy our civilisation.  Europe needs to assert itself and assert control over its borders before more of this horror is visited upon us.  I trust that that will be a lesson learned from this horrendous episode.

Steven Agnew: On behalf of the Green Party in Northern Ireland, I would like to express my condolences to the people of France, particularly those families who have suffered directly as a result of these attacks.  It is hard to understand the mindset of people who are so determined to cause misery, suffering and death and to think that, whilst we all join here in sympathy and sorrow, somewhere, there are those who celebrate those actions.  That is very difficult to fathom.  What is important is how we respond.  I look back to the response of the Norwegian Prime Minister after the horrendous atrocity that was committed by Anders Breivik.  His answer to the violence was that we need more democracy and more openness, but not naivety.  That is easy to say and difficult to achieve, but it has to be our starting point.  We must protect our way of life, but we must not do so by destroying it.
I have only questions, not answers.  My fear is that the simple answer to the complex questions and situations that we face is usually the wrong one.  We have to question how we respond.  My party stands on a platform of non-violence.  That is not to say that there should be no violence ever:  violence can be acceptable only if and when it prevents greater violence.  Again, I think that it is another principle with which we should underpin any response to these attacks.  I do not believe that fighting fire with fire is the way forward.  The way to mourn victims is not to create more innocent victims.
I wish the absolute best to those who are injured and in recovery and to the families who have been directly impacted by these attacks.  I stand in solidarity with that wider community.  This attack has had ripple effects throughout Europe.  I stand in solidarity with all those who absolutely abhor terrorism.

David McNarry: It is not that long ago that we in this House said, "Je suis Charlie" after those murders by ISIS.  We in UKIP offer our sincere condolences and sympathy to all those who have been bereaved and saddened by the carnage in Paris.  We think that we are right in speaking up for many people to demand that the evil perpetrators be brought to justice and that the horror of Paris is not repeated.
I note that COBRA has been meeting to mobilise national security.  That includes us.  I trust that our cities, towns and villages can be assured that they, too, are protected from attacks by ISIS just as people across the rest of the United Kingdom have that assurance.
Our best wishes to Paris.  Let us hope that we can all visit it for better times in the future.

Basil McCrea: Of course, we must send our condolences to those who have suffered and show our solidarity in standing with France at this tragic time.  One of the key questions that we might all consider, however, which has not yet been discussed in this Chamber, is why it is that France has become the focal point of the ISIS campaign.  Why is it that France is identified as the crusader whilst others are not?
I know that President Hollande will have been disappointed in the support that he had from some people when he wanted to take air strike initiatives.  There was a vote in the House of Commons, and there was a reference to the United States Congress, but Hollande and France were left standing alone.  That is why they are the ones who are identified as being at the point of this war.  We, therefore, all have decisions to make about whether we are going to stand four-square with them and whether we are going to do more than just issue words and platitudes.  We will have to consider what the right way forward is.
Mr Allister said that there are no good terrorists.  I suppose that the rejoinder to that is that there are no good wars.  What is the appropriate response that we all must make to this challenge to our democracy?  There is a danger that there will be a knee-jerk reaction against Islam and against Muslims.  The ISIS strategy is to divide humanity.  Not all those people are bad people.  We must find a way to show our humanity and our support.  We must win hearts and minds.  That is the way forward, and it requires cool, calm and calculated thought and not necessarily a knee-jerk reaction.

Edwin Poots: As we all realised the scale of what happened on Friday evening, we were shocked and stunned at the events.  The fact that so many people lost their lives is something that we should all draw on, as well as the pain that has been caused to all the families that are involved.  Such an unmitigated waste of human life is an absolute tragedy.
It makes us think back a little to the 7/7 murders that took place in London and the 9/11 murders in New York, which emanated from similar sources.  A little further back, we go back to the murders in Omagh, Teebane, on Bloody Friday, in McGurk's bar, and the Shankill bombing.  These things are all the same; they all happen when someone else thinks that they have a right, for a cause, to go out and take other people's lives — innocent people's lives.  Of the 129 people who are reported dead, eight of those are not innocent victims but murdering terrorists, and we must always remember that.  Those people are not in the same classification as the innocent victims in Paris from many parts of the world.
We need to reflect on our policies.  Mr McCrea and Mr Allister spoke about that from different angles, but the foolishness of opening up borders without having any checks or balances is ludicrously stupid.  We need to be compassionate to people who are in desperate situations, and we need to support them, but allowing an absolute free flow across our borders without any checks or balances being put in place will inevitably lead to more people with a terrorist background coming into Europe.  That is totally unacceptable.
I have taken my family on holiday to France many times, and we have spent many wonderful times in that beautiful country.  Today, we stand with the people of France.  Vive la France, vive la liberté.

Claire Sugden: I take no pleasure in joining Members of this House to express my horror and deep sadness at the events in Paris on Friday evening.  I offer my sincere condolences to those who have been bereaved of those lives that were taken so callously by others.  When a loved one is taken from you at the hands of another, the pain sears through your whole being and that pain never leaves you; it scars you.  Mr Speaker, it takes a special kind of bastard to inflict that pain on so many.  I apologise for my language, but I really cannot think of any other word to describe them.  Friday's events were inhumane.  They were carried out by bad people driven by a gross misinterpretation of religion and God.  They have no place among us.  I stand by the people of France and all the people of the world who are fighting against this evil.

David McIlveen: I, too, offer our sincere sympathies to the people of Paris today, who no doubt find themselves still under an immense shadow of darkness over the events that unfolded over the weekend.  I remember that, on 26 June last year, I had the opportunity to go to a concert in the Bataclan, and it was a place of happiness and celebration.  It was a place where people of all different creeds, colours  and races gathered together to enjoy an event.  For those who have not been in the venue, it is comparable in size and layout to the Ulster Hall in Belfast and has limited points of exit.  To think of those cowardly, grotesque, inhumane people coming into the building and opening fire indiscriminately while the poor people who were contained therein had really no easy means of escape is just horrific beyond any description or explanation.
One of the founding principles of France was the principle of liberty and of freedom.  This was an attack on freedom.  It was an attack on those of us who believe in the right of each individual country and each individual people to determine their own direction of travel.  It was a grotesque attack on that principle.  The rise of Islamic terrorism throughout the world has spread like a cancer.  There have been attacks throughout many cities in many places — everywhere from New York to Jerusalem to Paris to Beirut.  We have seen it in London, and we have seen it right across many major cities in the world.
I find myself agreeing with what a number of colleagues have expressed today.  With cancer in a physical sense, you do not talk to cancer.  You do not persuade cancer to leave a person's body.  You have to deal with it aggressively.  You have to deal with it in the right way.  We have to be very careful, Mr Speaker.  This is not a war on Islam or on any religion, but this is and should be a war on terrorism and on the very people who threaten the liberty of the people of France and on the people who threaten the freedom of the people of Europe and the Western World.  I urge our Government in Westminster to step up to the mark now and rally behind those countries that are taking a forward-thinking approach to dealing with this blight of terrorism that we find in our country at this time.

Mr Speaker: Thank you.  I will make one point.  We are talking about very emotional and terrible circumstances, and I regret the fact that one Member departed from what I thought was a very appropriate level of discussion and conversation.  Despite the circumstances, I see no excuse for that departure, and I hope that it does not happen again.

Assembly Business

Committee Membership

Mr Speaker: As with similar motions, the motion will be treated as a business motion, and there will be no debate.
Resolved:
That Lord Morrow replace Mr Paul Girvan as a member of the Committee for Enterprise, Trade and Investment; and that Mr Paul Girvan replace Lord Morrow as a member of the Committee for the Environment. — [Mr Weir.]

Executive Committee Business

Pension Schemes Bill:  Consideration Stage

Mr Speaker: I call on the Minister for Social Development to move the Consideration Stage of the Pension Schemes Bill.
Moved. — [Mr Storey (The Minister for Social Development).]

Mr Speaker: No amendments have been tabled to the Bill.  I propose, therefore, by leave of the Assembly, to group the 53 clauses of the Bill for the Question on stand part, followed by the two schedules and the long title.
Clauses 1 to 53 ordered to stand part of the Bill.
Schedules 1 and 2 agreed to.
Long title agreed to.

Mr Speaker: That concludes the Consideration Stage of the Pension Schemes Bill.  The Bill stands referred to the Speaker.  Thank you, Minister.

Private Members' Business

Human Transplantation Bill:  Second Stage

Mr Speaker: I call Mrs Jo-Anne Dobson to move the Second Stage of the Human Transplantation Bill and to open the debate.

Jo-Anne Dobson: I beg to move
That the Second Stage of the Human Transplantation Bill [NIA 64/11-16] be agreed.
I welcome the opportunity to move the Bill.  I rise to speak, first, as a mother of a transplant recipient and as an unashamed lifelong supporter of the life-saving and life-giving power of organ transplantation.  I feel that it is only right that, in the Chamber, we reflect our life's experiences in what we do and seek to achieve as elected Members, in the interests of all our constituents.
If Members will allow me to be personal for a moment, long before I entered politics, our life as a family was turned upside down with the birth of our second son, Mark.  We knew when he was five weeks old and diagnosed with severe reflux of the kidneys that he would be very ill throughout his young life and would eventually need a kidney transplant.  We never knew when that would happen but, at the age of 13, his kidneys began to slowly shut down.  The wonderful staff at Craigavon Area Hospital and then the Royal Belfast Hospital for Sick Children, including the amazing Professor Maurice Savage, Dr Mary O'Connor, renal nurse Hazel Gibson and her team, became our second family.  They loved and cared for Mark as if he was their own.  I will never ever be able to repay those 15 years of care that we received during the seemingly endless journeys to and from, initially, Craigavon, and then the children's hospital, before his transplant.
Like every transplant patient, Mark celebrates two birthdays each year:  his real birthday on 20 March, and the birthday of his new life on 5 February.  In all life's experiences — birth, marriage and, ultimately and unfortunately, death — nothing can, could or should ever prepare a young mother, as I was, to look at the very real prospect of losing her son or daughter.  I faced that prospect, and I firmly believe that it shapes you as a person for the rest of your life.  It gives a real sense of priority and focus, and, in our case, it strengthened an already strong faith at that time and has done so ever since. 
Now that Mark is through his transplant and has returned to his fit and generally healthy self, he knows too well the responsibility that comes with looking after the precious gift that saved his life.  I know countless transplant patients who, in their daily lives, seek to honour that gift and honour the donor in all that they do.  Three years after his transplant, when he became 18, Mark moved from the care of the children's hospital to the wonderful care of Dr Aisling Courtney, the clinical lead for transplantation in Belfast City Hospital, and, more recently, to Dr Neil Morgan, consultant nephrologist at Daisy Hill Hospital, Newry.
In our home, we know what it is like to have someone save the life of our son because of a kidney donated by someone who died in England on 4 February 2009.  We think of that person and their family every single day, but we will never know who they are.  Like many families, we have sent a letter, and we hope that they have received comfort in knowing how we appreciate, from the bottom of our hearts, the gift of new life that Mark has received.
Medical staff have played an important part in Mark's life and my family's life, and they play an equally important role in the lives of countless families touched by organ donation across Northern Ireland.  It is for that very personal reason that I took the decision to bring forward the private Member's Bill.  I want more parents to be able to see their son or daughter transformed back to having a fit and healthy life before their eyes, just as we saw with Mark, to move back from being a mere shadow of themselves, which they become following organ failure, and to see more people being released from a life sentence of dialysis and returning to as normal a life as possible.
The plain truth about organ donation is that the number of available organs does not meet the demand; and that, in a nutshell, is the reason why a change in legislation is required.  I fully appreciate that this will be an emotional and, for many, a sensitive debate.  I encourage Members to keep the recipients and donors at the forefront of their thoughts when making their contributions today.
I will spend a little time laying out the current stark reality facing local people when it comes to organ transplantation.  The first and perhaps most striking thing is that 17 people from Northern Ireland died last year while waiting on a life-saving transplant.  The local average is 15 people every year.  In 2013, 932 local people underwent kidney dialysis, which is a three-times-a-week life sentence.  In a sense, they are the luckier ones.  There is no dialysis for people who need a heart, liver, lung or other organ.  The only option for them is to receive an organ or to die.
Figures from National Health Service Blood and Transplant (NHSBT) provided to us by Assembly Research — and I pay tribute to it for the pack it has provided us with for this debate — show that, at the end of September this year, 162 local people were on the transplant waiting list.  That is made up of 117 patients waiting for a kidney, five for a kidney and pancreas, seven for a heart, 13 for lungs, one for a heart and lung and 19 for a liver.  Indeed, the figures for September this year see the highest number of patients waiting on a transplant for organs other than a kidney in the last four years where we have available figures.
It is also equally important to point out that the figures show us that there were no heart transplants conducted in Northern Ireland for Northern Ireland patients last year.  That is a point that I know is being highlighted by the British Heart Foundation.  That is despite five local patients receiving a heart transplant in each of the two previous years and four in 2011-12.  Focusing on the transplant waiting list, that is 162 local people and their families who are waiting, watching and wondering when that all-important call will come to let them know that a match organ has been found.
Statistics should never be used to mask or hide the human reality felt by patients.  Behind each and every one of those patients is an individual story of pain and anguish.  None of us know when and if we may need an organ at some stage to save our lives.  Anyone could be waiting on that life-saving telephone call; and those who have been in that position — and I know what it feels like — are best placed to describe it; but they are the lucky ones because, for them, that call came.  For others, it is too late, that time has passed and that call will never ever come.
I well remember presenting to the Health Committee in 2013, and I was joined by Mr William Johnston, who is now chairman of the Northern Ireland Kidney Patients' Association.  William waited for over 17 years until he received that call and had his transplant last year; but, on that day, when he presented to the Health Committee and the security guard at the door of the Senate Chamber asked him to turn off his mobile phone before he entered the room to present to the Committee, William fixed him with a stare and said, "My phone is never switched off.  I never ever know when that call might come".  I think that that highlights starkly for us the human reality behind the statistics and figures.
Last year, 17 people from Northern Ireland died while they were waiting on that telephone call to let them know that a match organ had become available.  Members, for them, that call will never come.  It is for them and for future generations that we need to adopt a different approach; to lift our eyes from the present to a future where organ donation is not viewed an exception but rather the norm.
Members, we often get much criticism in this Building for failing to bring forward legislation that brings a real benefit to the lives of people right across Northern Ireland.  Few issues could be more important than introducing legislation in the Chamber that increases life chances and gives all our people — our constituents — greater hope for a new life after an organ transplant.  Medicine has moved on considerably since the organ donor register was first introduced some decades ago.  I believe that, as a devolved region of the United Kingdom with the right to frame our own legislation, we should follow the lead of the Welsh Government, through their Health Minister, Mark Drakeford AM, and my colleague Anne McTaggart MSP in Scotland, and work together to achieve the right Bill for Northern Ireland.
I am, however, a single MLA working alongside the Bill Office to bring forward a Bill of this extent and importance.  I obviously do not have the Health Minister's army of staff and resources or, indeed, the equal armies of staff of the First Minister or deputy First Minister to bring forward this Bill.  That is why I want to say at the outset that I am happy to work alongside any Member on any aspect of the Bill and would welcome input, help and assistance in bringing it further through the Assembly processes.  I am also looking forward to a close working relationship with the Department of Health, and the Minister will be aware that, two weeks ago, I had a preliminary meeting with one of his directors.  I am hopeful that this will provide help and assistance in the weeks and months ahead.
I am certainly open to improvements and changes that will achieve the right Bill for Northern Ireland.  I very much welcome the support of the First Minister and recognise that he has given a clear commitment to me in the House to support the Bill.  His views on the soft opt-out system were clear when, in response to Joe Brolly and Shane Finnegan when they asked him about the movement to change the law, he said:
"If somebody dies in hospital, they need an organ, so the family are asked. How is that different from the family being asked in an opt-out situation?"
That is a key point.   I welcome the support for the Bill from the First Minister and the deputy First Minister, from Members across the Chamber, from councils and from MPs from all the local parties at Westminster.  I would also like to commend the support that I have received from the volunteers and officers of the local and national charities, who work so hard to promote organ donation and for whom the donor families are the real heroes.
Each year, Dame Mary Peters, who until last year was Lord Lieutenant of Belfast, presents certificates to families of those who have donated life-saving organs following the death of a loved one.  That is a fitting tribute to our amazing donor families in Northern Ireland by Northern Ireland's own ambassador, who is a lady in every sense of the word.  I was delighted to receive her support for the Bill progressing today, and she joins a long list, including the majority of the public, in supporting the move to a soft opt-out system for Northern Ireland.
Looking through political party websites and manifestos is not something that I often find the time to do.  However, they make for interesting reading.  I have been delighted to see reference in manifestos, on party websites and in press releases to organ donation policies and, specifically, to support for the soft opt-out system.  To give a flavour, I welcome its inclusion in the Green Party's policies as well as in the Alliance Party's 2012 manifesto.  I welcome the support of Sinn Féin and the SDLP for the issue, and I know that Mark Durkan MP has been a regular attender and supporter at the all-party parliamentary group for transplantation at Westminster.
Equally, the DUP's 2010 Westminster manifesto included the line:
"In order to improve public health the DUP supports ... presumed consent for organ donation."
I welcome my party's continued support for the introduction of a soft opt-out system at a policy and personal level, and I thank all political parties that responded to the consultation.
Whilst discussing the political stances towards organ donation, I am conscious that this matter should — and, in my opinion, will — remain well above party politics.  We have more than enough policy issues that divide us in the Chamber, but on this issue, surely, as the Second Stage goes forward, we can unite and work together to introduce something that the public, our constituents, supports.
I like nothing more than taking time to visit renal units and chat to patients undergoing dialysis.  For some, a transplant is not an option, and they are resigned to the fact that they will end their days on dialysis.  For others, it is all about giving them hope.  I am thinking of one family that I know where 12 members have a genetic renal condition.  It is a family that never knows how long their children, or any family member, will have until their kidneys fail.
Imagine what providing hope to that family would mean to them when faced with a possible future on dialysis for any family member — hope that a new life will come.  I firmly believe that, working together, we can deliver that hope to them, their family members and other families in the same position across Northern Ireland.
Let us also remember that one kidney transplant does not last a lifetime; kidney patients often require two or three transplants during their life.  They are also required to take a permanent course of immunosuppressive drugs to suppress the immune system, meaning that kidney transplant patients are prone to infection.
I was not alone in the House or among the organ donation community in being absolutely delighted to hear that the fantastic team at the City Hospital undertook five kidney transplants in one day in September.  Whilst a one-off, it shows that we have the expertise and capacity for kidney transplants.  However, I am conscious that that was a fantastic one-off event.  We all want to see more people being given that chance of a new life and the hope that they need to go on.  I firmly believe that a soft opt-out system will deliver that hope.  I have nothing but admiration for the amazing staff in the renal units.  We should be equally proud that our live donor programme at the City Hospital under Dr Aisling Courtney is the envy of clinicians across the world.  I visited it on a number of occasions and pay tribute to everyone involved in that programme and wish it continued success.
However, Luc Colenbie, head of Belgium's successful transplant strategy, told me in Brussels at the beginning of the year that their experience was that live donor programmes will eventually reach a plateau.  Belgium has a positive culture towards organ donation, in part because policymakers made the issue a national priority.  When they switched to an opt-out system in 1986, there was an 86% rise in the number of kidneys retrieved for life-saving transplants.  That change generated a positive change in the public's perception of organ donation that resulted in roughly 2% of their 11 million population saying that they did not wish to donate organs after death.
I apologise to my fellow Committee members if some of my contribution overlaps with my presentation to the Committee two Wednesdays ago, but these are important issues and central to the reasons behind the Bill.
One thing that I learnt over the past few years in bringing forward the Bill is that our local organ donation system is complex and confusing.
Indeed, a greater proportion of our transplants, currently 68%, come from people who have had no interaction at all with the organ donor register during their lifetime than from those who have.
Another aspect of our current system is that, even though we are one of the most giving people, with wide support in society for organ donation, we still have a relatively high bedside refusal rate, roughly 40% to 45%.  That is another aspect where figures differ between opt-in and opt-out countries across Europe.  Our high rate suggests that, prior to death, people often have not had that all-important conversation with their loved ones about their wishes.  In other opt-in countries in Europe, the average refusal rate is roughly between 40% and 60%.  As I said, in Northern Ireland ,we are around 40% to 45%.
In opt-out societies, however, the rejection rate tends to be much lower, at between 2% and 15%.  The bedside rejection rate in Belgium, incidentally, is closer to 2%.  That fits in very well with the PHA's findings that 96% of local families agree to donation, if they know their loved one's wishes.  So, the figures suggest that, in opt-out countries, such conversations are taking place and, when it comes to asking the family whether they know and can confirm the wishes of their loved ones, they will be in a better place to understand and articulate those wishes.

Alastair Ross: I appreciate the Member giving way.  She highlights some of the opt-out countries where there has clearly been success, though I would contend that that success is to do with other mechanisms in their systems, rather than just the opt-out.  She would, of course, acknowledge that there are other countries, such as Sweden, Brazil, Chile and a raft of others, that have moved to an opt-out system and their rates are worse than those we have in the United Kingdom and far worse than those in Northern Ireland.  So, there is no real correlation between whether you have an opt-in or opt-out system.  It is more to do with other issues, such as public awareness and experts in hospitals.

Jo-Anne Dobson: I thank the Member for his intervention.  That is precisely why clause 1 sets out that we need an education programme as well.  If he reads the Hansard report of my speech, he will find that I referred to the fact that opt-out should go in line with the education programme as well, which is crucial for everyone to make their wishes known.
I take a moment to break down the main aspects of the Bill's content for Members.  It is fair to say that, of the 22 clauses, the most important are towards the beginning of the Bill.  The first clause places a duty on the Health Minister to promote human transplantation and to conduct a yearly campaign to inform the public how the new opt-out system would operate in practice, including the role of the family in affirming consent.  The second, third and fourth clauses set out the requirement for there to be appropriate consent before a transplant can be lawfully conducted and cover, in detail, the two types of consent.
"Express consent" is where the individual can provide their own consent for a live donation; has engaged with the organ donor register to make their wishes known; appoints two advocates; or has placed their wishes in a will.  That is the current procedure and, for donations after death, is subject to a procedure conducted by clinicians, where the family is required to provide express written consent to confirm the individual's wishes prior to donation proceeding.  The Bill makes no change whatsoever to that current practice.  If someone, for whatever reason, is opposed organ donation, they will, for the first time, be able to engage with the register to opt off and their family will not be approached at the time of their death.
The second form of consent is "deemed consent", where there was no interaction between the individual and the organ donor register during their lifetime.  Following death, and in the knowledge that they have not engaged with the organ donor register during their lifetime, it will be deemed that they have provided the necessary consent for transplantation to proceed.
However, crucially, and I have always said this, consent is subject to family affirmation prior to donation taking place.  This is included in clause 4.  That is why having the conversation amongst family members and loved ones is so important, and I have always said that a duty to promote, as contained in clause 1, would be central to increasing public awareness.

Stewart Dickson: Will the Member give way?

Jo-Anne Dobson: No, I want to make my points.
It has been said many times in the Chamber that education is critical as we look to the future of organ donation in Northern Ireland.  We should be focusing now on the needs of local families in five, 10, 15 or even 20 years' time.
There are certainly many lessons that I believe we can and should learn from the experiences of other countries.  I come back to Belgium for a moment.  It has a fantastic programme in its schools, where, from an early age, the power of saving lives through donation is introduced into the curriculum.  I wrote some time ago to the Education Minister calling for the introduction of a similar system in our schools.  In Belgium, they have changed the public view of organ donation from being an exception to being the norm.  I believe that we can learn from those experiences.
I will now address some of the concerns raised during the recent Committee meeting.  I commend the idea of people being able to nominate advocates when they sign up to the organ donor register.  Concerns were raised about family members who may have an opposing view on organ donation.  This is where advocates play such an important role.  Advocates provide people with the opportunity to nominate someone to make the decision if they do not want to make it themselves at the time.  The Public Health Agency's (PHA)  consultation identified what it termed the "ick" factor amongst some respondents who simply did not want to make a decision or consider the issue.
The advocate would also have a role where someone has a specific wish or instruction that they wanted carried out after death.  They could appoint someone to make that decision for them.  If the person were to die in circumstances where donation is possible, their advocates would be asked if organs should be donated.  Equally, if the advocates nominated have predeceased the person or cannot be contacted at the time, a family member or relation could be contacted and asked to provide consent.  This is similar to the current situation when someone has interacted with the register during their lifetime.
We should also remember that there is a window of time after death during which clinicians may use an organ for transplantation.  I stand to be corrected, but I believe that it is roughly 24 hours for a kidney, which is one of the most robust organs under the circumstances.  That is why I feel that it is not advisable for people to make their wishes known in a will, because by the time it is actioned, the window may well be closed and transplantation will not be able to take place.
Concerns were also raised to the Committee about conflict between family members over providing consent for donation, something that can arise at present, albeit rarely.  This is more likely when a family has not had that important conversation, and that situation is one the Bill seeks to resolve through greater public awareness.  Initially, having the conversation between family members is the best way to avoid the situation.  However, we have exceptional specialist nurses in organ donation, who are trained to deal with these situations and advise families at the time.
I support the crucial role that family plays in the process, not least because death does not just affect the person who has died but the whole family, who have a role to play.  The consultation identified a willingness to retain the crucial role of the family in providing consent for organ donation to proceed, and that is clearly in place at present for express, as it is in the Bill for deemed, consent.
On 4 June 2013 I launched my public consultation for this Bill.  I am also grateful to the Public Health Agency for the findings of its two consultations on public attitudes towards organ donation, conducted initially in the same year.  At that time, I wrote to each Member and provided them with a copy of the consultation document.  In my letter, I reiterated that my door has always been open.  I thank those Members who have taken the opportunity to meet me to discuss the Bill and to respond to the consultation.
The public consultation ran for 16 weeks and received 1,366 responses.  Those responses were made both online and offline, and came from a mix of the general public, charities, councils, churches, the health and social care sector, political parties and others.  A summary report was produced in October of that year, giving an overview of the 10 questions and the responses to them.  That report is available in the Library and details responses that were positive, as well as concerns raised in answer to each question.  It showed that 82% of respondents supported a change in the law and a move to a soft opt-out system.  Also, 61% supported the attainment of the key role of the family and 86% supported protecting the rights of those who lack capacity in the legislation.  Those views have been well reflected in the Bill.
I want, again, to record my thanks to each and every person and organisation who took the time to respond.  I also want to record my grateful thanks to the local charities of the Transplant Forum as well as the British Medical Association, the British Heart Foundation, Opt for Life and others for their support in promoting the consultation.
In addition to my own consultation, the Public Health Agency conducted a consultation on public attitudes, also in June 2013.  More recently, a PHA survey with figures from February this year again highlighted public attitudes to organ donation.  The Public Health Agency survey highlighted 56% support for a move to a soft opt-out system in June 2013.  That grew in the PHA's most recent survey to 61% of the public supporting a move to a soft opt-out system.  Again, in 2013, 18% of the 1,012 respondents to the Public Health Agency's consultation were opposed to a change in the law geared towards soft opt-out.  In 2015, that figure dropped to 10%, signalling a clear change in attitude, with the percentage of those opposed almost halved.  That reduction could, possibly, be a result of the continued hard work of local charities, as well as the PHA's important 'Speak up and save a life' campaign, with its two powerful television adverts and associated campaigns.  Few people can have failed to see the leaflets, posters and billboards, and that is precisely what clause 1 of the Bill envisages when it comes to public education.  A continued programme such as that must be central to the future of organ donation.
It is also noteworthy that, in responses to the PHA's 2015 survey, 79% of the public agreed with the statement:  "The soft OPT-OUT system will result in more lives being saved".  The equivalent figure in 2013 was lower, at 74%, and I pay tribute to all of those involved in the charities associated with the continued promotion that is having an impact on the public's view on this issue.
When the Welsh Government decided to go down the route of a soft opt-out system, their surveys concluded that 49% of the public in Wales supported changing the law.  As I said, the equivalent figure here was 56% in 2013 and at present, from the 2015 figures, we have a figure of 61%, according to the Public Health Agency.  That shows clear evidence of public support from the majority of people for changing the law and that they believe that the move to a soft opt-out system will result in more lives being saved.
I would like now to focus on the finances.  No one can ever put a price on what it is like for a transplant recipient to receive a new life; as a family, we know this in our home.  However, there will inevitably be cost implications with this Bill.  The Assembly research service has produced a research paper that looked into the implementation costs of the legislation.
The paper, which is entitled 'Organ Donation Bill:  Estimated Financial Costs and Benefits' is available in the Assembly Library.  I should also say that I look forward to working with the Department as we look in greater detail to the cost figures.
Assembly research estimated that implementation costs for the Bill would be between £2 million and £5 million over a 10-year period.  Based on the assumption that implementation would be two years after the passage of the Bill, it reached the conclusion that the net discounted financial benefits from achieving one additional transplant a year over a 10-year period by organ type are as follows:  £4·6 million for kidney; £6·3 million for liver; £2·3 million for heart; and £1·4 million for lung.  More up-to-date figures from the Department will help to provide greater clarity.  However, the paper's conclusion on the cost benefit to the health service of increasing transplant numbers is startling; it could be as much as £7·4 million net benefit to the Northern Ireland economy.
To give just one example, focusing on kidney patients for a moment, the average cost of keeping a patient alive through renal dialysis is £30,800 per patient per year.  It is roughly £17,500 per patient per year for a patient on peritoneal dialysis and £35,000 per patient per year for a patient on hospital haemodialysis.
In response to an oral question that I asked in the Chamber, the then Health Minister, Mr Poots, confirmed that, in 2013, 932 local patients underwent dialysis.  That meant a total cost of over £29 million to the health budget, based on NHS cost estimates, in one year alone.  Each kidney transplant costs roughly £17,000 per patient.  Post-transplant, the yearly cost of immunosuppressive medication is roughly £5,000 per patient, meaning that, for each kidney patient who receives a transplant, the NHS estimates that it receives a saving of £25,800 in the second and subsequent years.  That obviously does not take into account the benefits of people returning to a normal life and the impact on their families, community and wider society.
It is very clear that the lack of available organs is placing major stresses and strains on local patients' families.  One of the major reasons for that is that all transplants for local patients, with the exception of kidney transplants, are conducted in hospitals in other regions of the United Kingdom.  Liver transplants for adults are conducted in King's College Hospital, London, and for children in Birmingham Children's Hospital.  Heart and lung transplants take place at Freeman Hospital in Newcastle.  Imagine the long and difficult trips back and forward to those hospitals and the anguish and pain while they live with their condition while waiting on an organ.
The lack of available organs means that patients must endure a greater number of trips from home to hospitals across the country, at considerable strain to them and their families, and considerable cost to the health service.  Increasing the availability of organs increases life chances and decreases stress, as well as reducing financial costs.  I believe that the Bill will achieve that.
Recent figures from the British Heart Foundation reveal that there are 10 people in Northern Ireland on the waiting list for a heart transplant and one person waiting for a heart and lung transplant.  According to the latest NHS transplant statistics — I mentioned this earlier — no one from Northern Ireland received a heart transplant last year.  Can you imagine the stress and worry of those 10 patients and their families, often making multiple journeys to hospitals far away from home?  They are arduous journeys for seriously ill patients.  In some cases — I know this from experience — it is with hopes built up, only to be dashed when, for any number of reasons, a transplant cannot take place.  That is sadly more common than it may seem.  The arrangements for transporting patients from Northern Ireland to hospitals across England are complex.
Last year, I had the opportunity to visit the NHS Blood and Transplant organ donation and transplantation directorate in Bristol.  It is miraculous to see that all transplants in the UK are coordinated through one tiny room in the middle of an industrial estate in Bristol.  We are very fortunate to be part of the wider UK network, which allows patients to benefit from organs that are donated in the rest of the UK and vice versa.
Mark's kidney came from a donor in England and was held up by snow.  That meant that, even though we had reached the hospital, his kidney had not.  The team in NHSBT would have allocated the kidney to the next match on the list if the weather conditions had not improved.  Thankfully, conditions improved and the organ arrived in Belfast healthy and within the timescale window for transplant.
Those are issues that few tend to consider when thinking about organ donation, albeit that they are important issues.  That office in Bristol is where they match an organ to a patient and start the process by which patients receive the call, which I spoke about earlier.  For me, visiting that room was quite a surreal experience, because I knew that that was where, with the call on 4 February 2009, the process started when an organ had been found for Mark.  It was an emotional visit for me, and I was delighted to spend time with staff who operate that vital service 24 hours a day, 365 days a year.  I was also delighted to meet Sally Johnson, NHSBT's director of organ donation and transplantation, and her team who maintain the organ donor register database.  We discussed the future of the register and the likely impact of the Human Transplantation (Wales) Bill being passed at the Welsh Assembly.
I understand that — the then Minister Poots confirmed it — local patients can register on the Republic of Ireland's transplant register, but that means that they cannot be on the UK register at the same time.  I also understand that arrangements are in place that make it possible for organ retrieval teams from the Republic of Ireland to operate in Northern Ireland.  It may be useful to seek clarity on that issue from the Department.
Last year, I was also grateful for the opportunity to meet the Welsh Health Minister, Mark Drakeford AM, in Cardiff.  I also hosted Mark and Anne McTaggart MSP at a Long Gallery event just over a year ago.
Following my conversations with Sally at NHSBT, I was absolutely delighted when the new organ donor register was launched across the United Kingdom in July.  That was a direct result of the Welsh legislation that comes into force next month, two years after being passed by the Assembly there, which is the same timescale that I have proposed in the Bill.  The changes to the register included the provision for people to be a donor, to not be a donor or to nominate two advocates to help affirm and make that decision for them after death.  I also very much welcome the fact that the Health Minister warmly welcomed those changes.  However, it is important to note that we would need legislation to come into place through the Assembly here to enable us to avail ourselves of the changes, which, I understand, our health service has rightly paid its portion towards.  This Bill makes those changes.
Under the current opt-in system, we have never broken through the glass ceiling of the mid-30%s of the public in Northern Ireland signing the organ donor register and consenting to donation after death.  That is despite decades of promotion by the charities and the recent campaign by the Public Health Agency.  From the perspective of someone who has been working alongside the charities for over 20 years, I know that that campaign was very much welcomed, given the heavy lifting that the charities have been doing and continue to do, day in and day out.
One of the little-known facts is that signing the register does not guarantee that a person's organs can or will be used after their death.  That is because the manner of an individual's death often determines whether it is possible.  The donation rate in the UK is 26 donors per million of our population.  People often assume that, if they join the register, it automatically means that they will donate their organs.
The facts are very different indeed.  Donald Cairnduff, whose son Philip had a successful liver transplant in 2004, joined me in presenting to the Health Committee two weeks ago.  I believe he explained it best when he used a footballing analogy.  He asked the Committee to imagine, on the last day of the Premier League season, when all the games kick off at the same time, that every stadium hosting a home game is packed to capacity.  Only 26 people among all those spectators in all those stadiums will become organ donors.  Just 26; very long odds indeed.
That gives you a vivid idea of how rare it is for people to die in circumstances in which they can donate their organs.  However, with over 90% of the population consistently supporting organ donation and people in their mid-30s pledging in the register, there is a considerable difference between pledges to donate and support for donation.  Indeed, as I mentioned earlier, 68% of our donations come from people who have never interacted with the organ donor register during their lifetime.  That feeds into the argument that I laid out earlier on our currently high bedside rejection rates, standing as they are between 40% and 45%.  This is frighteningly high and shows that families have perhaps not had the crucial conversation about donating that would have enabled them to better know what their loved ones' wishes were.  They could then have confirmed and honoured those wishes by signing a document that is required by clinicians prior the loved ones' organs being donated.
The Bill does not propose to make any changes to the current system operated by clinicians, when an individual has already signed the organ donor register and has consented to donate their organs after death.  I am also pleased by the three local public consultations into the issue of organ donation in Northern Ireland.  The findings of the two PHA consultations into the issue of organ donation in Northern Ireland have been largely in line with the findings of my consultation for the Bill.  I am also thankful that these consultations were conducted in parallel, as I believe that they too show that public support for a new opt-out system is rising.  They also provide an independent assessment of the public's views on this issue.
It stood out for me that, when asked, only 36% of the public knew that the organ donor register existed in the first place.  If you ask any of the countless local transplant volunteers, many of them are waiting for an organ transplant themselves, are successful recipients of a transplant, are family members of those who have donated or been recipients of an organ, or are people who, in some way, have an emotional connection with organ donation.  They will tell you that it is their sole life's purpose and drive to increase the number of organs available for transplantation.  Members, these people deserve our respect, gratitude and praise.  They are the true heroes in Northern Ireland, and they have absolutely nothing but my admiration and praise for all that they do to help increase the life chances of others.
It must never, ever be forgotten that behind each volunteer is an individual story of emotion and one that will tug at the very heartstrings.  We have heard so many of their stories through the all-party group, which I am honoured to chair.  I am delighted by the fact that it has become an efficient vehicle to bring to the Assembly the stories behind human transplantation, whether it be an individual's story, the fantastic success of the transplant games athletes from Northern Ireland or the views of individual groups and charities.
Organ donation has a voice in this Building.  I, for one, am truly glad that that is, and will continue to be, the case.  I am truly humbled and delighted, as a mother of a transplant recipient, to be included in their number, and to work towards an aim that many of them have held close to their hearts for many decades.  Members, I am asking you to join this campaign today.  I will say in the House again what I have said many times before, that I bring the Bill forward first as a mother of a transplant recipient and as an organ donation campaigner who happens to be a Member of this legislative Assembly.
It is with a deep sense of pride and purpose that I commend the Second Stage of the Human Transplantation Bill to the House.  I look forward to Members' contributions to the debate and the ongoing help and assistance to deliver the best Bill possible for the people of Northern Ireland.  We owe it to the present generation who are awaiting a transplant, and we owe it to future generations to come, to change the law and to improve the life chances for all our people.

Some Members: Hear, hear.

Maeve McLaughlin: Go raibh maith agat, a Cheann Comhairle.  I thank the Bill sponsor for that very detailed overview of the Second Stage.  On behalf of the Committee for Health, Social Services and Public Safety, I note the introduction of the Human Transplantation Bill.  As the Bill sponsor outlined, the principal objective of the Bill is to save lives — that is very clear — by changing organ donation laws, by introducing a new soft opt-out option with safeguards and by placing an additional duty on the Department to educate the public on organ transplantation.
The Committee heard evidence from the Bill sponsor on 4 November 2015, accompanied by the father of a recipient of a successful liver transplant.  We heard at first hand how successful organ transplants not only save lives but enable people to live their lives more fully — for example, by freeing them from the need for dialysis.  The Bill sponsor also spoke about the differences between express consent and deemed consent and the role that families and advocates would play in decision-making under the Bill.  The Bill sponsor provided the Committee with a range of statistical information, some of which has been referred to today.  It is quite stark when we hear that, on average, 15 people die waiting for a life-saving transplant locally each year; in fact, 17 people died waiting last year.  That is a stark reminder for all of us.  We also heard about the results of the three consultations on organ donation that have taken place in the last year — the consultation on the Bill and the two consultations by the Public Health Agency.  During the evidence session, the Bill sponsor stated that the majority of respondents to the consultation on the Bill and the PHA's attitudes surveys were supportive of some sort of soft opt-out option.
The Committee appreciates the importance of the issue of human organ transplantation, and there is an acceptance that more must be done to improve donor levels and transplantation rates.  The Bill has the potential to affect every one of us, and that was emphasised by Committee members.  It has to be acknowledged that there are wide-ranging opinions and feelings on the subject of organ donation.  Regardless of whether people support organ donation itself or are themselves on the organ donor register, there are differing views on the soft opt-out option proposed in the Bill.
Some Committee members have some concerns around the Bill, and there are a number of areas that will need further exploration and clarification.  Some of those areas were raised during the recent evidence session with the Bill sponsor.  An obvious concern was that of consent.  The introduction of the soft opt-out option was discussed, and members spoke of how organ donation is approached in other countries — the Bill sponsor has referred to some of that today — such as Wales, Belgium and Spain, and what levels of success they have had in relation to donor and transplantation rates.
We also know that further affirmation will be sought after death unless a person had already taken their name off the register before death.  That affirmation can come from family members, advocates or others as outlined in the Bill.  Although the affirmation is intended as a safeguard, it has the potential to raise issues.  Consent to organ donation is a difficult decision for families to take, particularly at a time of terrible grief and loss, and it is made even more difficult if there are differences of opinion between family members or others involved.  During our evidence session with the Bill sponsor, a number of members outlined possible scenarios whereby consent might be disputed; for example, where there is a potential donor who has expressed consent to organ donation and has perhaps appointed advocates, but whose family is opposed.
Other scenarios include those where family cannot be located or where there is disagreement between the next of kin.  In those circumstances, who has the balance of power?
Another issue raised was the role that clinicians play.  Are they expected to make decisions that may go against families’ wishes?  Importantly, how do they feel about the proposed legislation?  Should the Bill pass Second Stage, the Committee will want to hear from those clinicians who will be making the judgements and decisions on the ground.
Some Members raised the point that many people view organ donation as a gift freely given and expressed concern that the proposed changes to the law could alter that.  Another issue discussed in our evidence session was finance, and the Bill's sponsor alluded to some of the statistics, and whilst it is apparent, no one can put a price on good health.  The issue of finance needs to be considered.
The Committee heard evidence on the cost of implementing the Bill, the cost of dialysis for kidney patients, and the cost of transplant surgery.  Initial figures produced by the Assembly Research and Information Service indicate that it would take between £2 million and £5 million to implement the Bill.  However, the Bill's sponsor advised that the net benefit to the health service and the local economy of increasing transplants could be as much as a £7·4 million.
The Bill proposes to place additional duties on the Department to promote transplantation and to provide information about transplantation through a campaign at least once a year.  That is intended to raise public understanding of organ donation and to make it more socially acceptable to discuss the issue.  It is clear that education and communication are key if any change is to be effected in donor and transplantation rates.  Some feel that a cultural change is also needed so that organ donation is discussed openly and frankly, particularly between family members, and the wishes of potential donors may be known, making it easier for next of kin to take that difficult decision if the time comes.
The Human Transplantation Bill is an emotive and complex piece of legislation, and, should it pass Second Stage, the Committee will consider all the issues raised and report its opinion to the Assembly.

Alastair Ross: I thank the Member for giving way.  I have listened intently to what she said.  She mentioned consent being raised as a concern by some Members.  The Health Committee has looked at this Bill and at a range of other Bills in which consent is an issue.  Is she aware of any other area of medicine in which silence from an individual on an issue is deemed as their consent to do something to their body?

Maeve McLaughlin: Go raibh maith agat.  I thank the Member for his intervention.  I was going mention consent in my comments as an MLA.  We need to be very clear not only on the issue of consent but on the issue of conflict, as it may arise.  I was about to say that I hope that some of the issues that need to be reflected in the Bill will be progressed in that manner.
I thank the Bill's sponsor for bringing the Bill to the House today.  The Committee notes the Second Stage of the Bill.  As a constituency MLA, I look forward to engaging with, and maybe enhancing and strengthening, the Bill as it passes further stages.  Go raibh maith agat.

Alex Easton: The Human Transplantation Bill makes provision concerning the consent required for the removal, storage and use of human organs and tissue for transplantation and connected purposes.  It must be enacted by the Northern Ireland Assembly and assented to by Her Majesty The Queen.
Under the Bill, the Department of Health, Social Services and Public Safety must promote transplantation.  It must also provide information and increase awareness of transplantation and inform the public about the circumstances where consent to transplantation is deemed to have been given and the role of relatives and friends in affirming that deemed consent.  That also includes a duty to promote a campaign informing the public at least once a year.
The Bill contains 22 clauses and one schedule.  It is proposed that the Bill will seek to increase the availability of organs for the purpose of transplantation through a consent process requiring affirmation after death unless the person has already taken their name off the organ donor register.
At the moment, human transplantation is governed by the Human Tissue Act 2004, which is a piece of law that applies to England, Wales and Northern Ireland.  It is stated that, if the Bill becomes law, it will fit into the general framework already established by that Act.  Some parts of the Bill repeat the provisions of that Act and make them apply to transplants under the Bill.  Some parts follow the approach taken by the Human Transplantation (Wales) Act 2013.  The Human Transplantation Bill will result in consequential amendments to the Human Tissue Act 2004.  Those amendments will see a number of sections of the Human Tissue Act becoming non applicable to Northern Ireland, and restrictions will be put in place where consent is required.
The sponsor of the Bill undertook an extensive public consultation over 16 weeks on the policy objectives and proposed approaches of the Bill.  A total of 1,366 responses were registered, from which it is said that a sizeable majority agreed with the objectives of the Bill.  The majority of respondents stated that they believed that legislation and the introduction of a soft opt-out system would make a greater number of organs available for transplantation and therefore increase the chance of saving lives.  A clear majority of respondents to the consultation also agreed that the family should continue to play a key role in the decision as to whether donors should have their organs removed.
At the end of the consultation, the sponsor gave a detailed overview of the responses to each of the questions available to the public.  The overview included the number and percentage of each response and an overview of positive comments made and concerns expressed about each.  The sponsor also briefed the Stormont all-party group on organ donation as to the findings of the consultation.  I ask the sponsor this:  how many of those who undertook the public consultation were from a medical background or worked in the field of medicine?  The Royal College of Surgeons has expressed concerns in a recent article.  I wish to hear from it.  We need to hear more from the medical world on this issue before any final decision is made on the Bill.
I also note a letter sent to me by Dr John D Woods, the BMA Northern Ireland council chair, in which he mentions concerns over clause 4(2).  He states:
"We realise that family involvement is a sensitive issue but the proposal at clause 4(2), Deemed Consent:  deceased adults, we believe could lead to confusion."
He then goes on to offer an amendment.  It is something that we maybe need to examine.
The Bill before us today has the potential to affect every single person across Northern Ireland at some stage.  The sponsor of the Bill is bringing it forward with good intent.  However, I still need to have further information on various issues as the Bill reaches the Committee Stage for scrutiny and clarification and to gain a better knowledge of the facts for myself before I can reach a conclusion.  I am open-minded, but I need to be sure on issues such as costs.  How will everybody be informed?  How will people be able to take themselves off the list?  What about dealing with sensitive issues of asking loved ones to give consent after their family member has passed away?  What about training for staff on these issues?  Will this boost organ donation?  We see from some countries that it actually has not but that it has in others.  Will there be too many donors?  If so, will organs be sent to other regions of the United Kingdom or even further afield?  I am also keen to see what it means under the Welsh model and how it is going to work there.  I want to speak to the transplantation teams and explore the Welsh model.
Those are all questions that need to be explored.  I ask that the Bill be given the proper time at Committee Stage, rather than being rushed through, so that we get all the facts.  It is a vital issue.  I thank the sponsor of the Bill for bringing it forward for consideration to the House.  I hope to get a better understanding of the Bill as it progresses.

Fearghal McKinney: I welcome the opportunity to contribute to today's extremely important debate, and I am grateful to Mrs Dobson for bringing it to the Chamber.  I know that she has worked extremely hard over the last few years in pushing for a legislative change to organ donation law to ensure that the many people on waiting lists have the best possible prospects for receiving a life-changing transplant.  I encourage Members to think about that as we continue our discourse around the subject.  Mrs Dobson and her staff deserve the highest recognition in the Chamber for their sustained hard work in bringing forward the Bill.  Indeed, their contribution to the Committee reflected the depth and breadth of that hard work, and that has been reflected again, today, with the weight of her contribution.
As we have heard, about 200 people in Northern Ireland are waiting for an organ transplant.  Sadly, 17 died last year, as we have heard, long before being offered one.  So, it is important that the Chamber does everything it can to ensure that people on waiting lists have the best chance of receiving a life-changing organ.  As I said, I urge Members to consider those lost lives and the, potentially, increasing number of lost lives, when they reflect on all these issues.
I welcome today's debate.  Perhaps, the most important aspect of it is whether we move from an opt-in to an opt-out system.  An opt-out system, as we have heard, requires an individual to explicitly make it known while they are alive that they are not in favour of their organs being used for transplant when they die.  The key difference is that an opt-in system involves people expressly stating a wish that their organs and tissues be used for transplant on their death, while an opt-out system assumes that organs and tissues are available for transplant, unless there is a specific instruction to the contrary.  At the moment, the fundamental principle is that organs are donated actively, freely, voluntarily and unconditionally using a soft opt-in system.
The proposed change is to promote organ donation more widely and raise levels of consent, improve public awareness and ensure best practice at all stages of the donation process, but the decision that we in Northern Ireland need to make around a change in the law involving organ donation involves ethical, legal, medical, organisational and societal components.  The important balance to be struck is between respecting the views and rights of a potential donor and their respective families, and obtaining organs in an efficient manner.  As I said, the weight of the contribution by Mrs Dobson and her team, at Committee and the Assembly, reflects real depth and a consideration of those issues.
In considering the change to an opt-out system, the Welsh system, which comes into effect next month, provides key guidance.  Welsh authorities have stated that the process for opting out would be very straightforward, with people being able to opt out at general practitioner surgeries, online or by phone.  The Welsh system presumes consent, but allows people to opt out.  They can also confirm their wish to opt in.  If no preference is registered, the assumption is that they wish to donate.  At the time of death, the family is asked whether they know whether the person wished to opt out.  They are not asked to make a choice, but simply to confirm, if they can, their loved one's wishes.  If they do not know their loved one's wishes, donation is presumed.  However, I welcome the concept around the proposer of the Bill's ideas on advocates.
During the past two years between —

Alastair Ross: Will the Member give way?

Fearghal McKinney: Yes.

Alastair Ross: The Member has been on the Health Committee and has been a health spokesperson for some time.  Does he share the concern that the Bill would make the absence of an objection to being considered as an organ donor equal to somebody who has expressly said that they wish to be an organ donor?  Is he not concerned that silence on the issue is going to be deemed as consent?  As I asked the Chair, earlier; is he aware of anywhere else in medicine where consent is presumed or deemed by any member of staff?

Fearghal McKinney: I do not share the concern.  I am interested in the way that the Member phrases it.  He asks if I have a concern.  I do not have a concern.  Clearly, he does have a concern, and he has the right to reflect it.  I think that that is the importance of this discussion; we must have the debate and put in as many safeguards as we can around this.  As I said at the outset of my remarks, we are talking here about lost lives and the ability to do something about that; trying to reach out to the community in a way that allows people to make decisions about potential organ donation and raising public awareness of it.
Fundamentally, I understand — I will get to some of the finances in a moment — that it is very important that we treat this debate in the most respectful way possible.  I re-emphasise that the depth and breadth of the work here, and the outreach that is being done by the proposer of the Bill — the scale of that work and interrogation of the issues — will allow us, particularly me and lots of people in the community who will have concerns about this, to move forward in the most comfortable way possible, so that we do not allow fears to be raised where potentially they could be allayed.  That is an important and mature way to approach this debate.  I know that the Member will also want to approach the debate in that way.
During the past two years, between passing the Act and its coming into force, the Welsh Government and health authorities have engaged in that process of awareness raising and education to ensure that people in Wales are aware of the changes to the law and the new choices that they will have.
As I said, I would just like to touch on the finances.  We know that the costs involved with the introduction of the new system in Wales, estimated to be £7·5 million, are being set aside to support a range of activities around the change there.  I know that the Member has touched on this.  We would have to have meaningful funding for awareness campaigns as well.  The Welsh Health Minister has advised that all the evidence that is available suggests that if Wales were able to secure just two more kidney donations, the system would pay for itself, given the cost of kidney dialysis.  While I would not want anybody to set aside their concerns and worries about some of the proposals, I think that there is weight in the Bill's proposers taking that money-saving aspect of it very much into consideration.  If two people could be taken off dialysis, the cost savings would cover the cost of the law change.  It is extremely significant.  In fact, it seems almost incredible that such a small change in the number of donations could cover the cost of that legislation.  In fairness, that did indeed grab the Committee's attention.
There is much to do from this point to ensure that the Bill is right.  I repeat that I think that we should welcome the debate.  Moving forward, let us interrogate the issues at Committee in a respectful and mature way so that the people of Northern Ireland know that when it comes to looking at saving people's lives, the Assembly has arrived at the most mature point that it can in a positive way, with full public awareness and the right resources being directed towards these new proposals, and so that the people of Northern Ireland know that we have done it for their benefit and for the very vulnerable people who, as I said at the outset, are still waiting on that phone call.  Let us see whether we can arrive at a point where more phone calls can be made and more lives can be saved.

Mr Speaker: Not to curtail or discourage your contribution in any way, Mr McGimpsey, especially as you were a previous Minister in this brief, I will just indicate briefly that Question Time is at 2.00 pm, and I may need to interrupt you to allow it to proceed.

Michael McGimpsey: Thank you, Mr Speaker.  I rise to support the Bill's Second Stage and indeed to thank Mrs Dobson for bringing it forward.  I know the huge amount of work that has gone on in the background to get it to this stage.  The situation can of course simply be put by the fact that we are losing patients annually for want of appropriate organs for transplant.  Organs are absolutely life-saving in situations.  We often talk about kidney dialysis.  We assume that patients with kidney failure go on dialysis and that although it is inconvenient and might be difficult for them, it offers them a way out.  In fact, the process has a limit.  There is a limiting factor in it.  Without appropriate donation, it lasts only so long.
Without organ donation and kidney transplant, patients will perish.  I know that from personal experience of a friend of mine whom we lost last summer; he had been on dialysis for about five years but perished after that for want of a kidney.
That is particularly difficult for individuals and families, but it is especially difficult for children.  We have situations in Northern Ireland where we are losing wee ones with their entire lives ahead of them and who could have their lives back and could be saved for want of the appropriate donation.  Again, I had experience of that when I was Health Minister.  I have no doubt that the Health Minister, when he visits the Children's Hospital now, will meet children in exactly that situation.  If they had the appropriate support, by which I mean organ donation, those children would get their lives back.  When you are looking at wee ones of two, three and four years of age and think that they have a prognosis of only a year or two because of this situation, that is very difficult for families and for the doctors, nurses and staff dealing with that situation.
We have an opportunity here, through this process.  The Bill is by no means done and dusted, and very important points were raised by Mr Easton and others that we need further information.  We will want that information at Committee Stage to allow us to come to an informed decision.  That is appropriate; that is what should happen with a Bill such as this.  That is exactly what we should be doing, and I believe that that is exactly what the Committee will be doing.  That is the appropriate way forward.
Issues have also been raised about consent and how it is freely given.  We need to ensure that we have the views of donors, families and relatives.  That is particularly important when talking about children, who do not have the capacity and who rely on their families.  Those are all key issues.  They are very difficult issues for the families concerned and for many adults in that situation.  Those are things that we need to face.  By facing them, we are saving lives, and that is what our health service is about and what we are about in the House.  We must find a way forward that can provide life-saving interventions for patients who would not survive without them, and if we decide not to go forward with this legislation, that is, in effect, what we will be doing.  We will be saying to a number of patients that we cannot help them, knowing that their prognosis will certainly be that they will come to harm.
I support the Bill and will continue to do so through its Committee Stage.  There are important questions that have to be asked, and information is required.  I believe that all those questions can be answered satisfactorily to allow us to go forward.  It will be ground-breaking for us in the Assembly, and for our health service, to take those steps.  It will also be strongly welcomed by our doctors and nurses working in the health service, who will have an opportunity to provide that key, special intervention.  We have a workforce that is, by and large, dedicated to providing the very best support that they possibly can for their patients.  It is up to us to give them the support and resources to allow them to deliver that.
Mr Speaker, I got your warning at the beginning about time.  I do not need a huge amount of time to deliberate this through.  I think that the Committee Stage is an appropriate stage to take it to and at which to deal with a number of these issues.  In principle, for the prize that we get out of this, for the gain that we will make, for the lives that we will save and for the lives that will be lost if we do not go forward with this piece of legislation, I am happy to stop there, Mr Speaker, for the moment as far as this Bill is concerned other than to indicate again that I fully support this proposal.

Mr Speaker: Can I assume that you have completed your contribution?

Michael McGimpsey: Yes.

Mr Speaker: Thank you very much.  As Question Time begins at 2.00 pm, I suggest that the House takes its ease until then.  This debate will continue after Question Time, when the next listed Member to speak is Mr Stewart Dickson.
The debate stood suspended.
(Mr Deputy Speaker [Mr Beggs] in the Chair)

Oral Answers to Questions — Finance and Personnel

Budget: Expenditure Limits

Kieran McCarthy: 1. Mr McCarthy asked the Minister of Finance and Personnel for an update on the process to agree a Budget that matches expected expenditure limits following the 2015 spending review. (AQO 9069/11-16)

Arlene Foster: The UK spending review 2015 will determine the Executive’s Budget allocation for the five years commencing 2016-17.  The outcome of the spending review will be announced on 25 November 2015.  I will bring a Budget to the Executive and the Assembly for consideration after that date.

Kieran McCarthy: I thank the Minister for her response.  Given the very tight timings between now and the start of the next financial year, how can she ensure that a strategic approach will be adopted that reflects emerging priorities such as investing in skills and, indeed, growing our economy?

Arlene Foster: I thank the Member for his question.  He has put his finger on the problem that faces us in this spending review.  Ordinarily, we would issue and consult on a draft Budget, and that would give us time to listen to all the stakeholders and, indeed, all the Members here about how to address strategic priorities.  However, given the lateness of the spending review, on 25 November, we are having to look at different ways of engaging with stakeholders.  We cannot go through the process that we normally go through for the draft Budget and confirming the Budget, so I am considering alternative ways of seeking the views of stakeholders to make sure that we hear from all the voices about what the priorities should be.
As for whether it should be a one-year Budget or a multi-year Budget, obviously, I am of the opinion that it should be a one-year Budget because we will be entering a new mandate after May next year, and it would not be right to set budgetary priorities without allowing the new Executive to set those in the new Programme for Government.  Of course, it is a matter for the Executive as a whole, but it is my opinion that we should just set a one-year Budget.

Dominic Bradley: Go raibh míle maith agat, a LeasCheann Comhairle.  I thank the Minister for her answers up to now.  If she is not to hold a formal consultation on her draft Budget, how will she engage with stakeholders?

Arlene Foster: That is what we are considering at present.  As I said, the preferable way would be to have the usual 12-week consultation on the draft Budget and allow people from all the different sectors affected to put forward what they believe is the right way to move ahead.  However, we will have to be more targeted.  Presumably, we will hold events to go out and engage with different sectors on what we think are the emerging priorities for the Budget.  We simply do not have the time to engage in a draft Budget process, and I regret that.  Indeed, I regret the fact that we do not have clarity on where Westminster is going in the comprehensive spending review.  There has been not much negotiation, or meetings, on how the devolved institutions will be treated in the comprehensive spending review.  We have heard a lot about how some Departments at Westminster are facing cuts of up to 30%, which is an incredible amount of savings.  Unfortunately, we have not had much engagement with the Treasury or, indeed, the Chief Secretary to the Treasury on how this will impact the devolved Administrations.  That is a frustration that is shared by not only my Welsh colleague but my Scottish colleague, and we have raised it directly in correspondence.

Gordon Lyons: Can the Minister give the House her assessment of the Budget envelope for the next five years?

Arlene Foster: Of course, we will not know what the Budget envelope will be until it is announced by the Chancellor on 25 November.  Whilst we do not have the exact Budget envelope, the economic and fiscal outlook, as published by the Office for Budget Responsibility in July indicates that, once again, we in Northern Ireland will be largely protected from the worst of the cuts that will come to UK public expenditure.  However, we will continue to see a real-term reduction until around 2020-21.  That is when the Office for Budget Responsibility thinks that things will start to move in the opposite direction, but, as I said, we will have more clarity on 25 November when we will be able to look at how we are going to be directly impacted.

Michaela Boyle: What revenue-raising measures are the Executive considering, if any, ahead of a new Programme for Government?  Go raibh maith agat.

Arlene Foster: Hopefully, once we have completed the current talks process — I use the term "current", but, hopefully, it is the last talks process — in relation to the difficulties that we currently face, we will turn to looking at the Programme for Government for the next Administration and what the outcomes should be around all that.  Indeed, revenue raising will be looked at, but it is a very controversial area, and many in this House share with me the view that some of the revenue-raising options that have been suggested by others are simply not something that we would engage in, such as water charging.  This party has been very clear in relation to water charging.  We believe that it would be a retrograde step, particularly for householders who have been through a very difficult time over the past couple of years.  However, there is scope to look at other issues, and I think that we should look at other issues when we are thinking about the next Programme for Government.

Roy Beggs: I advise Members that questions 5 and 6 have been withdrawn.

Financial Position 2015-16

Paul Givan: 2. Mr Givan asked the Minister of Finance and Personnel for an update on the financial position of the Northern Ireland Executive for the 2015-16 financial year. (AQO 9070/11-16)

Leslie Cree: 7. Mr Cree asked the Minister of Finance and Personnel for an update on both the Executive's Budget position and financial plans for the remainder of 2015-16. (AQO 9075/11-16)

Fearghal McKinney: 10. Mr McKinney asked the Minister of Finance and Personnel for an update on the Executive's 2015-16 budgetary position. (AQO 9078/11-16)

Arlene Foster: With your permission, Mr Deputy Speaker, I will answer questions 2, 7 and 10 together.
I have commissioned a November monitoring round, with a view to seeking Executive agreement on outstanding budgetary issues in this financial year.  Departmental returns submitted as part of the process indicate that significant progress has been made in managing the significant pressures identified early in this financial year.  I will update the Assembly in due course, once Executive agreement on the November monitoring round has been secured.

Paul Givan: The Minister will be aware that critical to the completion of this financial year is the implementation of the Stormont House Agreement.  Can the Minister outline the financial impact to the Northern Ireland Executive's Budget if a deal is not reached?

Arlene Foster: I thank the Member for his question.  He will know that the Budget for this year — 2015-16 — is predicated on the Stormont House Agreement being implemented.  The financial consequences would be significant, if not dire, if the December 2014 Stormont House Agreement was not honoured.  There is no realistic way in which we could live within the 2015-16 DEL control total if the Stormont House Agreement flexibilities in particular are not dealt with.  The key financial pressures that would bite would be the need to pay a £100 million reserve claim for 2014-15 and the welfare reform costs, both of which would come out of our resource DEL.  It is very important that we reach agreement in relation to Stormont House and that we do so as soon as possible.

Leslie Cree: Further to question 7, can you advise how, with the difficult and very short time remaining, capital, including conventional and financial transactions, can be utilised before the end of March?  Is there a serious risk of money being returned to the Treasury?

Arlene Foster: I am sorry; I did not catch the very last part of that about the Treasury.

Leslie Cree: Will there be capital moneys returned to the Treasury at the end of March?

Arlene Foster: That is certainly not our plan in relation to the capital funding.  As I said, in June monitoring, there was a significant pressure appearing.  Very significant monitoring bids were made at that particular time.  I took the decision to write to all Departments to say to them that they needed to stop all discretionary spend.  I am very pleased to say that that had an impact and there is a greatly reduced monitoring round now in November, and we will be able to deal with that, hopefully, in the coming days when we will be able to make announcements.
As he knows, we are hoping to find a home for the financial transactions capital in the Northern Ireland investment fund so that we do not lose any financial transactions capital.  We believe that we have a home for normal capital, if I can call it that, as well, so we do not foresee any capital being handed back to the Treasury.

Voluntary Exit Scheme

Thomas Buchanan: 3. Mr Buchanan asked the Minister of Finance and Personnel for an update on the number of people who have left the Civil Service under the voluntary exit scheme. (AQO 9071/11-16)

Arlene Foster: Eight hundred and sixty-six employees left the Civil Service on 30 September; a further 1,540 will leave between 30 November and 31 January.  Those exits will deliver a pay bill saving in 2015-16 of £23·6 million and £69·1 million per annum thereafter.  The compensation cost will be £68·4 million.  Further offers will be made at the end of November for exits at the end of March.

Thomas Buchanan: I thank the Minister for her response.  Can she advise how staff are selected to leave?

Arlene Foster: Essentially, the selection criteria are being applied in order by Department grade, analogous grade and by discipline, where necessary, based on the numbers required by each Department to determine those who will exit under the scheme.  The first criterion is the best value for money score, using the least cost, which is upfront compensation payment, and the maximum payback — the resultant wage savings in a one-year period.  Where individuals are tied on that criterion, random selection is used thereafter.  The decision on which staff are to leave has been devolved to departmental level because we felt that Departments were best placed to make the decisions on the staff that they need.

Ian Milne: Go raibh maith agat, a LeasCheann Comhairle.  Is the Minister confident that the scheme will not be subject to a legal challenge by the unions?

Arlene Foster: Yes, as much as one can be confident that it will not be challenged by the unions.  We engaged, as you would expect, with our lawyers before the scheme was put in place, and, therefore, we very much believe that the legal basis is robust.  However, that does not stop others thinking that they may want to challenge, but I believe that we will be able to defend against any challenge that is brought.

Patsy McGlone: Go raibh maith agat, a LeasCheann Comhairle.  Mo bhuíochas leis an Aire as a freagraí.  I thank the Minister for her answers.  Can the Minister give an assurance that the reduction in personnel will not have a detrimental effect on front-line services, particularly given the experienced personnel who are leaving, or who are projected to leave, the service?

Arlene Foster: I made the point that we had devolved the decision to departmental level, and one reason that we did that was because the sheer scale of the exits and the speed with which they needed to happen meant that Departments had to be able to make sure that they would maintain appropriate service delivery.  Therefore, we wanted to ensure that essential employees, for example, were exempted from the scheme and wanted to allow Departments to deploy quotas, if that was considered necessary.  We did not allow employees to go all in one tranche.
As you know, it has been spread across the year, and they will be released over four tranches.  As I say, employees are released on a departmental basis.  Some Departments are allowing more to go than others, and constituents have been in touch with me about why the Department for Social Development is not allowing as many people to go as the Department for Employment and Learning.  Those are departmental decisions that they believe they can stand over.  It is a mixture of all those things, but it is about ensuring that Departments have resilience after the voluntary exit scheme has finished and to make sure that they can continue to deliver and maintain the public service that we expect from them.

Sandra Overend: It seems that certain grades of civil servants are not being allowed to leave at this time, and she has maybe touched on the reasoning for that.  Can she confirm whether that is true and whether everyone who wants to leave will be allowed to leave at some stage?

Arlene Foster: There may be grades that a Department feels are necessary to keep it functioning in the proper fashion, and some of those have been exempted from the scheme.  Each Department determined the numbers by grade that it needed to release under the scheme to secure the pay bill savings.  Corporate HR and my Department acted on those instructions.
Offers were made commensurate with the numbers to be released as determined by Departments rather than with reference to the total number of applicants within a business area or grade.  Some staff may be disappointed that they are not being allowed to avail themselves of the voluntary exit scheme, but we have to be mindful that we have a Civil Service to run and maintain, and that the public expect to have a level of service from their Civil Service.  Some will be disappointed, but that is tied in with the voluntary exit scheme.

Jim Allister: Is the Minister monitoring the impact of the exit scheme on the community background of the Civil Service composition?  If so, has she any grounds for concern, and when will that be revealed to the public?

Arlene Foster: That information will be fed into human resources and go to the Civil Service board, which will report on that.  I do not have figures at present, but I am sure that the Member will monitor that and ask me again, when I will be able to answer in more detail.

Defamation Act 2013

Anna Lo: 4. Ms Lo asked the Minister of Finance and Personnel for an update on any plans she has to introduce legislation similar to the Defamation Act 2013. (AQO 9072/11-16)

Arlene Foster: The Northern Ireland Law Commission was asked to assess the law of defamation by reference to the 2013 Act.  However, the commission ceased operations before it completed the review.  I have asked Dr Andrew Scott, who was undertaking the review on behalf of the commission, to produce a final report, and that report will help to inform policy direction.

Anna Lo: I am pleased to hear about the review.  I am sure the Minister is aware that the law in England and Wales has helped not only to ensure free speech but to deter reckless defamation claims.  Are there any clauses in the Bill that the Minister particularly objects to?

Arlene Foster: No.  I have no preconceptions about what should or should not be done.  Dr Scott is taking an independent look at what the needs are in Northern Ireland.  I was disappointed that he was not able to complete the review under the Law Commission.  However, we have asked him to complete that work.  Unfortunately, it will have to fit around his teaching commitments, but we hope that he will be able to deliver it in the new year.  I took forward to receiving it, considering it and looking at his recommendations.

Mike Nesbitt: The Minister makes reference to Dr Scott and the commission, which, as she will be aware, undertook a consultation.  Is she prepared to publish that consultation?

Arlene Foster: As I understand it, there were around 32 responses to that consultation.  I do not think that we should pre-empt Dr Scott's independent review.  Therefore, I will not be letting those consultation responses come out until Dr Scott has finished his review.  He is a very thorough individual, and I look forward to the work.  As I said, the review will have to fit around his teaching commitments at the London School of Economics.  I hope that the final report will be complete and available in the first months of 2016.

Alban Maginness: I thank the Minister for her interesting answer.  When the work done by Dr Scott comes into being, will the Minister go out to further consultation, or what process will she follow on foot of the report?

Arlene Foster: First of all, the Committee will receive a copy of the independent report, so it will be free to comment on it.  As Minister, I will have decisions to take on the foot of the report.  We do not know what those will be until we receive it.
If there are changes to be made, we will move into policy development to consider how we make them.  I do not think that it would be right to follow the Defamation Act 2013 slavishly.  Obviously, it will inform what we do, but we need to wait on the report and decide how to move forward, because, of course, it depends on what is in the report.

Rates: Food and Life Sciences Sector

Sydney Anderson: 8. Mr Anderson asked the Minister of Finance and Personnel how the review of business rates can help manufacturing companies in the food and life science sectors. (AQO 9076/11-16)

Arlene Foster: The review will re-examine all non-domestic rate reliefs and their continued relevance.  Currently, manufacturing companies in a wide range of the sector benefit from 70% industrial derating if the premises are used primarily for factory purposes and involve the use of manual labour.  That relief extends to the food sector.  Life sciences companies may also be entitled to it if a production process is involved.  However, research does not normally qualify for derating.  The public consultation paper sets out the case for retaining that support, recognising the importance of Northern Ireland maintaining its competitive position for manufacturing.

Sydney Anderson: I thank the Minister for that response.  Will she update the House on how the Executive support the manufacturing sector through rate relief?

Arlene Foster: Early in the last mandate, we took a decision to keep industrial derating, and that helps a lot of our companies across Northern Ireland.  Some 70% of their rates bill is given rate relief and, therefore, they pay 30% of what they would pay if they were in England, Wales or wherever.  We believe that that is of great assistance to manufacturing companies across Northern Ireland, whatever manufacturing sub-sector they are in.  As I said in the paper that has been put forward, we will not be changing that; we will keep it.  Some people have suggested that this review will lead to the end of industrial derating.  That is not the case, and I want to make that very clear today.

Máirtín Ó Muilleoir: I thank the Minister, especially for her commitment to keep industrial derating.  Following the review and the public consultation, does she believe that we will be able to come up with solutions to tackle some of the real problems facing small businesses in our high streets and main streets?  I think, in particular, of the number of empty stores and shops that pepper many of the main roads and streets in our towns and cities.

Arlene Foster: Absolutely.  The Member took part in a debate that we had recently in relation to the impact of rates on small businesses in South Belfast.  That was very worthwhile and useful because it allowed us to set out what is happening in relation to rate relief and the rating system in that constituency.  As he knows, small business rate relief has had a very good impact for many businesses across Northern Ireland.  Some say that it does not go far enough; some want us to change the system.  The current small business rate relief system runs only to the end of this financial year and then we will have to decide whether to keep it in its current form or to engage and do something slightly different for town centres.  That has been suggested to me.  The Member will know that the Ulster University economic policy centre suggested that we should do something different, rather than continue with the small business rate relief scheme.  I will take that decision in conjunction with colleagues in the Department for Social Development and the Department of Enterprise, Trade and Investment.  I have already met with both Ministers to see whether there is something we can do that would have more of an impact.  Certainly, moving into the future, we will continue to support small businesses.  It is just how we do it, whether through rates or another system.

Danny Kennedy: I am grateful to the Minister for her previous answers, particularly the latest.  Can she advise at this time whether all the existing rate relief schemes are likely to be extended to 2016-17.

Arlene Foster: No, I cannot say that.  There would not be much point in us having a review if I were to stand up and say that everything that is there at the moment will continue to be there in 2016-17.  It is important that we reiterate the situation in relation to manufacturing because of the difficult week that manufacturing has just been through with the number of job losses.  That is not to take away from the fact that, while last week and, indeed, the week before were particularly bad weeks for manufacturing, manufacturing is actually on the up in Northern Ireland, based on the number of jobs that have come to, and been created in, Northern Ireland over the past year.  However, I believe that, given other pressures, not least energy costs, it is right to keep derating for manufacturing businesses.  As I have said, small business rate relief is something we are looking at.  Whether it would be better to use the £20 million that was set aside for small business rate relief in a different way is a discussion that is ongoing.

Construction Contracts: SMEs

Maeve McLaughlin: 9. Ms Maeve McLaughlin asked the Minister of Finance and Personnel to outline the work her Department has undertaken to ensure that small and medium-sized enterprises have a competitive chance of bidding for tendered construction contracts. (AQO 9077/11-16)

Arlene Foster: My Department introduced new public contracts regulations in February 2015.  These are intended to facilitate the participation of small and medium-sized businesses by, for example, limiting turnover requirements to twice the contract value.  The Central Procurement Directorate (CPD) has also worked with the construction industry to simplify the pre-qualification process and reduce the effort needed to tender.  SMEs are now winning around 85% of construction contracts.  CPD has also published guidance to help SMEs benefit from subcontracting opportunities.

Maeve McLaughlin: Go raibh maith agat.  I thank the Minister for her answer.  Specifically on procurement and tendering, is the Minister minded to look at the Public Services (Social Value) Act 2012 in England?

Arlene Foster: Actually I held a procurement board meeting last week, and that was the subject of the discussion.  I received a very helpful report from a group of people, including the Strategic Investment Board, who have been running social contract pilots.  One of the queries was whether we go down the route of legislation or of guidance.  That discussion has really just begun.  I have asked for an Executive memorandum to go round colleagues asking what they feel is the best way forward on the issue.  The procurement board is looking at this issue at present.

Karen McKevitt: What has been done to remove prohibitive criteria that prevent companies winning tenders for the first time?

Arlene Foster: CPD has introduced a range of measures to increase opportunities for small and medium-sized companies, including those dipping their toes into the market for the first time.  A single web-based procurement portal, eTendersNI, has been introduced.  It shows all the public-sector procurement opportunities that are available and alerts firms to tender opportunities in which they may be interested.  It also allows them to store their profile information for use when completing further tenders.
Breaking larger contracts into lots is a very important method of allowing small and medium-sized businesses to come forward on their own behalf.  For a while it seemed that the only way that you could obtain a government contract was if you were part of a big partnership that went forward together.  However, we are now breaking larger contracts into lots to allow SMEs to come forward on their own behalf.
As I said, we are making sure that the turnover requirements are only twice the contract value.  Again, that was a big challenge for a lot of small and medium-sized businesses.  Indeed, I came across it in my constituency.  Setting proportionate minimum standards for experience and financial standing is also important.  In the past, standards were, quite rightly, being asked for, but when we looked at them we did not think that they were proportionate to the size of the contract.  We have tried to increase the opportunities for small and medium-sized businesses in a range of ways.  It is something that I feel very strongly about and take a particular interest in, having come from the Department of Enterprise, Trade and Investment.

Children's Bill: Pooled Budget

Steven Agnew: 11. Mr Agnew asked the Minister of Finance and Personnel how the pooled budget provisions in the Children's Services Co-operation Bill 2015 will operate in practice. (AQO 9079/11-16)

Arlene Foster: The Children’s Services Co-operation Bill 2015 states that the Department of Finance and Personnel may, by regulations, make provision for the procedures to be followed on the sharing of resources or pooling of funds.  Such regulations will be used to ensure that the handling of shared resources or pooled funds complies with DFP public expenditure and financial management guidance.  Accountability and governance issues will also be addressed.  Subject to the Bill receiving Royal Assent, DFP will work with OFMDFM and other stakeholders to draft such regulations.

Roy Beggs: Members, that ends the period for listed questions.  We now move to 15 minutes of topical questions.

Minimum Wage:  Departmental Budgets

Rosaleen McCorley: T1. Ms McCorley asked the Minister of Finance and Personnel to detail the implications of the new minimum wage for departmental budgets. (AQT 3121/11-16)

Rosaleen McCorley: An dtig liom iarraidh ar an Aire cad iad na himpleachtaí do bhuiséad a Roinne mar gheall ar an tuarastal is ísle nua?

Arlene Foster: I am not sure that the new minimum wage will have a big impact on departmental budgets.  When it comes in, the living wage will have an impact, particularly on the Department of Health and Social Services, because many of our care workers, for example, are paid in and around the minimum wage.  When they move on to the living wage, that will obviously be more expensive for the Department, and that will have to be taken into account when we set its budget.

Rosaleen McCorley: Go raibh maith agat.  Gabhaim buíochas leis an Aire as a freagra.
I thank the Minister for her answer.  What challenges will that pose for arm's-length bodies and community organisations?  What can government do to support those groups?

Arlene Foster: We must be aware of the scale of the issue.  I was recently contacted by some of the groups involved in the social care sector to say that it will have a big impact on them.  I know from the tourism and hospitality sector that it will be a big challenge there as well.  While we all welcome the fact that we are moving towards having a living-wage economy, we should be aware that there are challenges associated with it, particularly for the lower-paid sectors.  Whilst bigger employers in the private sector will be able to absorb those costs, it will be a challenge for us in the public sector.

Fisheries Conservancy Board:  Pensions

Daithí McKay: T2. Mr McKay asked the Minister of Finance and Personnel to take up the case of Mr William Owens of Broughshane, who worked for the Fisheries Conservancy Board (FCB) during the ‘80s, given that, even though he has evidence of his membership of the FCB pension scheme dated 1987, he has been denied his pension payable to age 64, even though other members of the scheme received same; and will she help Mr Owens and other people in that position to get the four years’ pension that they have been unjustly denied. (AQT 3122/11-16)

Arlene Foster: I thank the Member for his question.  I am aware of the individual whom he has brought before the House this afternoon; indeed, my colleagues have written to me about the issue, and Mr Owens has written to me directly about it.  It is being investigated by the Department.  I know that he may be a bit frustrated about the time that it has taken to look into the matter, but the Department is looking at it.

Daithí McKay: Go raibh maith agat, a LeasCheann Comhairle.  Many Members will be aware of Mr Owens's case; he has campaigned and canvassed for many years on the matter.  Is the Minister willing to meet Mr Owens to move the matter on?

Arlene Foster: I am prepared to come back to you and, indeed, to the other Members who have written to me about the matter, once the Department has finished its investigations and we can see where it is at at present.

Civil Service Recruitment:  Community Balance

Gregory Campbell: T3. Mr Campbell asked the Minister of Finance and Personnel to keep monitoring and under review the breakdown of community balance of people coming into the Civil Service, given that she will be aware that by far the majority of people recruited are at the administrative assistant (AA) and administrative officer (AO) grades. (AQT 3123/11-16)

Arlene Foster: Absolutely.  I know that the -matter concerns the Member greatly, and I will communicate with him on it once I have had a chance to look at the figures again for this year.  We will certainly look at whether there is a need for intervention in some way in relation to the recruitment of AOs and AAs.

Gregory Campbell: The Minister will be aware that, a considerable number of years ago, there was a concern because there were too few Protestant employees in the much larger section of the Civil Service than in any of the other sections.  Hopefully, she will be able to keep that matter under review and, if required, adopt a policy that other public-sector bodies have had to adopt, which is intervention to ensure that there is equitable treatment across the communities.

Arlene Foster: Absolutely.  I am aware that some arm's-length bodies have had to adopt that process, but, unfortunately, it has not had as much of an impact as I would have liked, because, in the circumstance that I am thinking of, that organisation was capped at 49 employees and, therefore, there was little room for movement on that matter. I take the Member's point and will certainly keep it under review.

Empty Premises:  Rates Review

Michaela Boyle: T4. Ms Boyle asked the Minister of Finance and Personnel whether she has given any thought to how, under the rates review, we might bring in some changes that would help to bring more businesses into empty premises across our towns and cities. (AQT 3124/11-16)

Arlene Foster: The Member will be aware that we already have provision that, if someone moves into an empty shop, they are able to avail themselves of rates relief for a limited time.  I accept that it is a limited time, but it helps when someone is starting up a new business.  I know of businesses in my constituency that have really appreciated that.  The non-domestic review has only started.  It runs, I think, until the middle of January, so I hope that Members and, indeed, stakeholders will come forward with new and innovative ideas, not just around rates relief but around all the other areas.

Michaela Boyle: I thank the Minister for her answer.  Minister, would you ever consider specifying certain areas — for example, a street in a town centre — where a special rates exemption would apply to empty stores?

Arlene Foster: Again, that is the kind of thing that we need to think about.  I mentioned the small business rate relief scheme.  Indeed, some town centre organisations believe that, instead of just having a generalised small business rate relief scheme, we should target it on the area in the town centre that, at present, is having difficulty, frankly, in filling spaces because of the level of rates that have been levied on the shops.
One area that has also been raised with me — it is a controversial area — is in the realm of charity shops.  Since the review went out, I have already had a number of charities in contact with me, worried about the fact that they will not be able to avail themselves of rates relief.  However, on the other hand, I have small businesses saying to me, "They are not paying any rates.  I am next door, and I pay full rates".  Those are the difficult decisions that we will have to grapple with, but we can and should look at doing things differently.  We should not just be driven by what everybody else does.  If there is a challenge in relation to town centres — frankly, some of our town centres are struggling — we should look at those and see if they can make a difference.

Rate Relief for Sports Clubs

David Hilditch: T6. Mr Hilditch asked the Minister of Finance and Personnel what progress has been made on rate relief for sports clubs since the private Member's Bill failed to pass. (AQT 3126/11-16)

Arlene Foster: The Bill that I intend to bring forward will contain an enabling power that will permit enhanced rate relief for sports clubs, subject to conditions.  My current intention is to use the power to permit enhanced relief of 100% for community amateur sports clubs that do not have a permanent liquor licence.  That deals with the issue of competition with hotels, pubs and clubs.  It would align them with the rating treatment of community halls legislation rather than putting them into competition with pubs and clubs.

David Hilditch: I and some of my colleagues met the Northern Ireland Federation of Clubs, which expressed some disappointment at the lack of consultation on the previous process.  Can the Minister ensure that the likes of those people will have the opportunity to fully engage in any new process?

Arlene Foster: Absolutely.  I hope that they will understand that, because of the short time that we have available, it will be a targeted consultation rather than the full 12 weeks of consultation.  I hope to go — indeed, I am going, God willing — to the Committee tomorrow morning to talk about my proposals.  It will be a matter for the Committee whether it grants accelerated passage.  If it grants accelerated passage, we can get the Bill through; if it decides against it, it will probably be a matter for the next mandate.  I will regret that, but it is a matter for the Committee.

Roy Beggs: Joe Byrne is not in his place.

Fraud

Paul Givan: T9. Mr Givan asked the Minister of Finance and Personnel, given that she will be aware of the case involving his constituent Amanda Jackson, who was subject to a £77,000 fraud, to outline to the public and to all the professional organisations involved in such transactions the need to be vigilant and the need to ensure that robust systems are in place to prevent such fraud in the future. (AQT 3129/11-16)

Arlene Foster: Yes, I am aware of your constituent's case.   It was, of course, raised publicly, but I also know that you corresponded with me on the matter.  I suppose that it really is a matter for my colleague the Enterprise Minister and about making sure that everything is in place in Trading Standards.  I urge vigilance on the issue that was brought to my attention.  There was an awful lot of money involved in that case, but, you know, small amounts of money in other cases mean a big lot to those individuals who have been defrauded.  We should be alert and aware of the dangers online.

Paul Givan: I thank the Minister for that response and for undertaking in her written correspondence to write on the issue to the Law Society, owing to its oversight of the legal profession.  Of particular concern is that, for electronic transfers, Barclays, with which I and the Member of Parliament have corresponded, does not check the name of accounts.  That is prevalent across all electronic transactions.  Is that something that the Minister could undertake to correspond on with the banking institutions?  Danske Bank was the organisation that allowed the money to go out, and Barclays allowed the money to be received into what was ultimately a fraudulent account that was set up in its organisation.

Arlene Foster: I am more than happy to do that if the Member wishes to give me the fuller details of that side of it.  I undertook to write to the Law Society as that end of it caused me a great deal of concern.  As he knows, we do not have any control over the banking systems in Northern Ireland.  That falls to the Westminster Government.  I am more than happy, however, to correspond with those banks about the incident.
Thousands if not millions of people transact their banking online every day.  We should not forget that that is the way in which people chose to do their business nowadays, and 99% of it is carried out in a very safe manner.  If there are instances in which there are difficulties — clearly, this is a case in which something went fundamentally wrong — we should raise it and make sure that it does not happen again.

Health Service Investment

Kieran McCarthy: T10. Mr McCarthy asked the Minister of Finance and Personnel whether she is willing and able to invest further in the health service to enable patients to be seen in a more reasonable time, bearing in mind that a request went to her Department during the June monitoring round for £45 million and the fact that she will be aware of the dire position with the ever-growing waiting lists. (AQT 3130/11-16)

Arlene Foster: In the 2015-16 Budget, I and my Executive colleagues demonstrated our commitment to improving health and social care by protecting front-line health and social care from budgetary reductions.  Further to that, some £200 million of additional funding was provided to the Department for front-line health and social care.  I am glad that my colleague is here to hear about all that great funding that has been provided to him by the Department of Finance.
Unfortunately, the deterioration in waiting times is due to a number of factors that are placing increasing pressures on our health service.  Those include demographic changes, which I have talked about in the House before, an ageing population and increasing demand for healthcare interventions.  However, all of that has been made worse by the fact that we have been incurring welfare fines that otherwise could have gone to the Department of Health.  I make no apology for saying that.  I hope that we are able to find a solution to the difficulties that we have found ourselves in over welfare so that money can be allocated to the Department of Health to deal with those issues.

Kieran McCarthy: I thank the Minister for her response.  She will remember that a former Finance Minister criticised a former Health Minister for not providing value for money.  Can the present Finance Minister assure the Assembly that the present Health Minister will deliver a better service for all our people, particularly on the waiting lists that we have just been talking about?

Simon Hamilton: "I have every confidence in him."

Arlene Foster: He is saying that I have every confidence.
[Laughter.]
I do have every confidence in my colleague the Minister of Health on the issue.  The key to all of this is to make sure that, after the talks have finished — we hope that they will finish very soon and that we will have an agreement in place — we can move to a sustainable budgetary position, where we can allocate the appropriate amount of money to the Department of Health and are able to deal with those waiting lists, which have accumulated and are unacceptable.  I think that we all accept that, but we are where we are.  Now, we have to deal with the issue, and I look forward to being able to make a statement in relation to November monitoring in the next number of days.

Roy Beggs: That is the end of the period for questions to the Minister of Finance and Personnel.

Oral Answers to Questions — Health, Social Services and Public Safety

Health Service Reforms

Maeve McLaughlin: 1. Ms Maeve McLaughlin asked the Minister of Health, Social Services and Public Safety to outline his plans for reforming the health service. (AQO 9084/11-16)

Peter Weir: 5. Mr Weir asked the Minister of Health, Social Services and Public Safety when the recently announced panel to examine the configuration of health and social care services will be appointed. (AQO 9088/11-16)

Adrian McQuillan: 15. Mr McQuillan asked the Minister of Health, Social Services and Public Safety how much will be saved through the abolition of the Health and Social Care Board. (AQO 9098/11-16)

Simon Hamilton: With your permission, Mr Deputy Speaker, I would like to answer questions 1, 5 and 15 together.
It has been clear for a number of years that our health and social care services in Northern Ireland are facing the significant challenges of rising demand, rising expectations and tightening finances.  We cannot hope to respond to those challenges unless we are focused on ensuring the highest quality and safety of care, configure our services correctly and have an appropriate administrative structure.
There are simply too many layers of administration in our system, which are making it difficult to meet those challenges to drive change and weakening accountability.  I want to drastically delayer the system to remove complexity and bring about greater accountability and better responsiveness.  I want our trusts to be responsible for the planning of care in their areas and to have the operational independence to deliver it.  I want to see my Department take firmer strategic control of the health and social care system.  I have therefore announced that we will close the Health and Social Care Board, as I believe that we no longer need a stand-alone organisation.  I intend to retain a Public Health Agency, with a renewed focus on early intervention and prevention, which will work more closely alongside the Department in that essential work.  I have also announced a panel to lead a debate on the best configuration of health and social care services in Northern Ireland.
It is important that this is a clinically led debate with clinical evidence for any proposed changes to services and evidence about the implications of failing to make changes.  I envisage a panel comprising around half a dozen experts drawn from across the sphere of health and social care.  I hope to be able to announce the membership of the panel shortly and that it will begin its work before Christmas.  One of its first tasks will be to convene a summit involving political parties to gather ideas, suggest solutions and, I hope, collectively reach agreement on a shared vision for the future of health and social care in Northern Ireland.
As I have said before, these changes are about moving towards a more streamlined and accountable structure so that we can make the most of the talent of our staff, encourage innovation and create a more efficient system.  Although there may be some savings, my focus is on getting the structures right.  All health and social care bodies are subject to challenging efficiency savings and, until detailed work is completed —

Roy Beggs: Does the Minister need extra time?

Simon Hamilton: Yes.  Sorry, Mr Deputy Speaker, I thought that that was requested beforehand, but I appreciate that.  Thank you.
All health and social care bodies are subject to challenging efficiency savings and, until detailed work has been completed, it is not possible to identify whether any additional savings can be delivered.  I hope that all political parties will embrace the opportunity for change and work positively to create a world-class health and social care system in Northern Ireland.

Maeve McLaughlin: Go raibh maith agat.  I thank the Minister for that detail.  I have been very welcoming of the reform agenda that he is taking forward.  The board's figures on waiting times for elective care were published for the period from April to August.  The figures showed that all trusts were failing to reach their targets and that one trust was actually 17% behind target.  Specifically, how will this reform proposal tackle that very direct need?

Simon Hamilton: I, again, welcome her welcome of the proposals that I put forward nearly a fortnight ago.  I particularly welcome that because I think that the Chair has taken the proposals that I put forward in the proper spirit, recognising the fact that there is an additional layer of bureaucracy in our system that is getting in the way of front-line delivery, which is what she focused on.  In the past, that has also proved a barrier to innovation across our health and social care system.  I think that she and I are as one in wanting to see that bureaucracy removed from our system.
The Finance Minister was just in her place, outlining the difficulties that we have this year with finances.  Pressures are increasing, driving up demand and our waiting lists, but we have also had the situation of losing money through welfare reform penalties.  I, like her, do not wish to dwell on that.  I hope that, in other parts of this Building and this estate, we will be able to reach a swift conclusion to the issues around our Budget and welfare reform that have been bedevilling us.
That will then result in a resolution of welfare reform, which will result in more money for waiting lists, and that is what I have been lobbying my colleague the Finance Minister for.  In the short and the long term, we need an injection of resources to tackle waiting lists.  That is what I am seeking, that is what I want, and that is what I hope will happen.  In and of themselves, those changes will not address that, other than the fact that they will make the £4·7 billion health and social care system in Northern Ireland work more efficiently.  By taking out the layer of bureaucracy that she and I have focused on, we can make that system — which has not been working to the full and to the optimum over the last number of years since its inception in 2009 — work more efficiently and get more resources into the front line.  I want to see any savings that are realised going back into the front line to help patients and people across Northern Ireland.

Peter Weir: In order to make the necessary changes, the Minister has always referred to the need for a transformation fund.  Will he advise us whether he envisages that extra income-generation measures will also be required?

Simon Hamilton: We need to be clear that in wanting to transform our health and social care system we need more resources.  That might seem almost counter-intuitive to wanting to get the most efficient use out of the resources that we have.  Understanding the pressures we face across our entire budget, we need to see more money going into health and social care in order to get a more efficient system.  In the short term, in order to make the changes that might come forward as a result of the recommendations from any panel a reality, we need a boost and an injection of cash over the next number of years.
If we want to do some of the innovative things that many of our trusts are doing, then we need to have money to do it, which is not money that is coming away from the front line.  That has been the challenge in the past.  We have had to fund innovation, and money has had to come from the front line, and that is never an easy thing to do.
In and of themselves, the reforms do not depend on more income generation.  The reintroduction of prescription charges might have been a way of getting more money into the system in the short term.  I am aware that a campaign has been running recently that is opposed to the reintroduction of prescription charges or, perhaps more accurately, wants to exempt certain people from prescription charges.  My view is that, if we were to reintroduce prescription charges, it should be for everyone, or we should stick with no one and have no exemptions.  Unfortunately, there has been a misunderstanding with the campaign; the proposal that was made in a recent consultation was for a small charge of around 50p or £1 up to a maximum of about £20 or £25 a year.  Given the lack of political consensus, I do not think that there will be any reintroduction of prescription charges in my time as Minister, but there will be consequences.  Not having the income from prescription charges is not without consequences in terms of paying for some of the very expensive new drugs and treatments that are out there.  Some people may see some success in not having prescription charges reintroduced, but there will be consequences, sometimes even for those —

Roy Beggs: The Minister's time is up.

Simon Hamilton: — who are very sick and rely on new drugs.

Adrian McQuillan: Minister, what impact, if any, will abolishing the board have on front-line services?

Simon Hamilton: There will be an impact on creating a more efficient system, which is what I want to see, and that is where the impact of the reforms that I have put forward will be most targeted on.  I do not want to dwell on staffing issues, because, as I said during my statement in Ballymena a couple of weeks ago, we have some tremendous staff in our system who are working exceptionally well and doing some exceptional things, but we are not getting the best out of their talents because of the system that they operate in — that very bureaucratic system that we have.
Some have wanted to focus on the issue of staff, saying that it was an easy decision to get rid of the board because its numbers had become big.  Yes, the numbers have risen.  It started pretty high; under the tenure of Mr McGimpsey when he was Health Minister, it started with around 390 full-time equivalents in the board, and it has grown to 600.  It was always quite a big beast no matter what his intentions were for it.
Over the same period — since 2010 — the number of staff in the Department of Health, Social Services and Public Safety has dropped dramatically.  In March 2010, the number of full-time equivalents in the Department was 670.  In November 2015 — the most up-to-date figure we have — the number of staff within the Department is 466.  So there has been a one-third reduction in the number of staff in the Department over the last four years, and that number is set to go down further.
The voluntary exit scheme, which my colleague the Finance Minister referenced earlier, will see 43 full-time equivalent posts removed from the Department by the end of 2015-16, which will make £0·5 million of savings in-year and £1·5 million recurring savings thereafter.  So, on the issue of the board's staffing levels, yes, it has grown in size, but a reduction in the number of staff in the Department has occurred over the same period.

Fearghal McKinney: The Transforming Your Care (TYC) plan had consensus but not enough money.  He is seeking further consensus and is pointing to the potential for money, but there is no guarantee that he can get it.  Is that not a fatal flaw in his plan?

Simon Hamilton: No, and we should not be looking for fatal flaws in the plan.  We should be seeking to build political consensus.
Sorry, I have not had the chance to formally congratulate the Member — I did so very informally earlier — on his victory at the weekend.  I will not say too much, given who is sitting directly behind him.  I congratulate him and I also congratulate Mr Eastwood, which makes me sound like a famous boxer thanking Mr Eastwood in the past.  Taking over the reins of the SDLP so close to an election is like taking over managerial office at a Premier League club that is sitting at the bottom of the table with only about 10 matches to go.  I am sure the Member and his party colleagues hope that he is more Tony Pulis than Felix Magath, but time will tell.  I wish him well.
We should be looking for a political consensus, because the prize from that is the crafting, building and putting in place of that world-class health and social care system.  We know what we can have in Northern Ireland, and Sir Liam Donaldson pointed to that in his report, and we all want to see that happen.  Yes, it absolutely does depend on resources.  I do not want to labour the points that I made to Mr Weir, but is absolutely requires resources to make that transformation.  That will require some difficult decisions by me and the Executive, but I hope that, given the extent of the prize and the size of the challenges that are facing our health and social care system, we can all unite as one to lobby for those additional resources so that we can put in place a transformation fund that will make the vision of a world-class health and social care system a reality.  I look to the Member as much as I look to any other Member for support in trying to realise that goal.

Michael McGimpsey: The changes that you propose are contained in Liam Donaldson's proposals.  At the Committee and in previous utterances you estimated that it would take 18 months to deliver this change.  I saw Liam Donaldson in the press over the weekend saying that that is far too long a time and that you must shorten it.  Have you reconsidered your time frame?

Simon Hamilton: I welcomed what Sir Liam Donaldson said when I made my speech, and I welcome the comments that he made last week.  He welcomed my decision to get rid of the board, and he did make the points about the timescale.  It is significant that he said we absolutely should be getting rid of the additional layer of bureaucracy in our health and social care system that was created, as the Member knows very well, back in 2009, so I welcome what Sir Liam said in respect of that.
I made the point about the implementation of possible recommendations that might flow from the work of a panel, namely that they may take between five years and 10 years to be implemented in full.  I used the 18-month figure for practical considerations:  it will be the time within which to pass and implement the legislation that will be required to do away with the board.  In between, officials have been tasked with scoping out what steps can be taken without the need for legislation to be passed and start to implement them as quickly as possible.  That is so that we can have the effect of the reforms that I have proposed, which are about taking out bureaucracy and focusing and encouraging innovation.  We can have all of that without needing to pass legislation.  Where we need to pass legislation, we will do so.  Being realistic about the timescale so close to an election and the dissolution of the Assembly, I do not believe that legislation will be able to be passed by the end of March.
Realistically, it will have to be introduced very quickly after the next election and implemented at the beginning of the next financial year.  The 18 months is a practical point.  I would like to see it happen more quickly; I wish that I could click my fingers and make it happen overnight, but, unfortunately, it cannot.

Autism Act 2011: Implementation

Dominic Bradley: 2. Mr D Bradley asked the Minister of Health, Social Services and Public Safety for an update on the implementation of the Autism Act (Northern Ireland) 2011. (AQO 9085/11-16)

Simon Hamilton: The Autism Act (NI) 2011 required my Department to lead on the development and implementation of a cross-departmental autism strategy.  Every Department has signed up to the strategy, and it is an important commitment for the Executive.  Although a report is not due until January 2017, given the focus on the issue, I have decided to provide Members with a detailed report on progress against the autism action plan.  I have therefore issued a written statement to Members advising that a progress report on the cross-departmental autism strategy 2013–2020 and action plan 2013-16 has been placed in the Assembly Library and has been published.
Many aspects of the strategy are progressing well, with better access to services for people with autism and their families and carers; the appointment of a regional ASD coordinator; and training for front-line staff, education professionals, youth workers, parents and carers.  There is also better awareness of support services through signposting by HSC trusts as part of their triaging process.  However, it is undoubtedly the case that the unprecedented increase in referrals has created a major challenge for the system.  Over the past six years, referrals of children and young people for assessment have nearly doubled from around 1,500 to 2,936 per year.  That has inevitably resulted in longer waiting times for the first assessment and ultimate diagnosis.  Therefore, while I am pleased with the progress made to date, there is no room for complacency.  I will continue to work with the board and the trusts to tackle the current difficulties and to improve access to services.

Dominic Bradley: Go raibh maith agat, a LeasCheann Comhairle.  Considering the importance of early diagnosis and intervention for people who have autism, does the Minister, since he is so fond of footballing metaphors, not see that he is in the bottom league regarding autism, given the fact that 1,400 people await diagnosis?

Simon Hamilton: I do not come to the House to give those figures or statistics with any sense of pride: far from it.  The Act has helped, along with many charities working in the field, to raise awareness of autism.  It is a positive thing that that has happened.  It has created a significant increase in demand: a doubling of the number of referrals.  As I said in my original answer, there has been an increase from 1,500 to nearly 3,000 this year.  Obviously, that puts an understandable pressure and strain on the resources that I have at my disposal.
I accept the point about early diagnosis.  Just because an ultimate diagnosis has not happened, that does not mean that there are not supports or interventions — quite the opposite. There are interventions that take place prior to ultimate diagnosis.  There is much work from community paediatrics, speech and language therapy, occupational therapy, social services and educational psychology as appropriate as an intervention, even in advance of diagnosis.  We are working hard to reduce the impact of the long waits by looking and reviewing autism assessment processes, which is quite a long and extensive process.  We are looking at what we can do to streamline that as much as possible while still having a high quality of diagnosis. We are also looking at standardising autism service models across all trusts and extending service capacity through the greater integration and alignment of autism services with other child development and young people's mental health services.  It is not that we have sat back and done nothing; it is not even as if, before diagnosis, nothing happens with interventions.  More could be done, but to deliver more we need more resources.  The Member knows full well the pressure on resources in the Department.  I hope that he will also appreciate and understand that the £9·5 million a month being lost through welfare reform penalties because of the failure of his party and others to live up to their commitments on welfare reform is costing —

Roy Beggs: The Member's time is up.

Simon Hamilton: The Member rolls his eyes, but it is a serious issue.  We cannot afford to lose that amount of money that could be going to the front line.

Roy Beggs: I ask Members to check that their mobile devices are off and not causing interference.

Gary Middleton: I thank the Minister for his answer so far.  Will the Minister outline how the numbers of assessments provided and the numbers of diagnoses of autism made have changed in recent years?

Simon Hamilton: The Bill became an Act in 2011.  Since just before that, as I mentioned to Mr Bradley, the number of referrals of children and young people for assessment has nearly doubled from around 1,500 to close to 3,000 this year, but resources have not increased at a commensurate rate.  We need to invest more.  I accept the point that Members have made: we absolutely need to invest more in getting staff into the front line.  We estimate that around 20 to 23 whole-time equivalent clinical staff are required.  The cost of doing that would be around £1 million of additional expenditure, so, when Members opposite roll their eyes about raising issues around welfare reform and the loss of £9·5 million every month, they should consider that £1 million out of that £9·5 million that is lost in one month would cover the increased costs. People take their positions on opposing welfare reform, but I hope that we can resolve those issues over the next number of days.  That will, I hope, free up more resources to go into the front line to deal with waiting lists and other problems.  There are consequences of taking the ideological position that some have taken in respect of welfare reform and not living up to the commitments that they made last year: we can see that in autism services, in waiting lists and elsewhere.

Kieran McCarthy: The Minister will be aware of the old saying "Prevention is better than cure".  The figures that the Minister has given us for youngsters being diagnosed with autism, which we know to be fact, are absolutely staggering.  Will the Minister advise the House whether proper investment is going to scientists and universities etc to try to establish the cause? The numbers are staggering, and it is going from bad to worse as the years go on.

Simon Hamilton: I do not have the expertise to delve into why there has been a doubling in a very short period.  It is a six-year period; it is not a lengthy period.  It is a very, very short period, during which we have had a doubling in referrals.  Perhaps, the fact that there is increased awareness of the existence of autism is one of the contributing factors; I think that that is fair to say.  I am free enough to say that there is, obviously, support and work going on in research.  The extent to which my Department contributes to, funds or supports that, I cannot say, but I am happy to write to the Member and inform him of what support we are involved in.  I know that we will be supporting in various ways through trusts, the PHA and others and in helping autism charities across Northern Ireland.  He and I will know of some that operate in our constituency.  I am sure that that is replicated around Northern Ireland.  I am sure that support is going to those from the health and social care sector, but I will inform the Member of the extent to which that is happening.

Cathal Boylan: Go raibh maith agat, a LeasCheann Comhairle.  Will the Minister ensure that all the partners in the autism plan will commit to playing their role in addressing autism?

Simon Hamilton: As I said in my original response, all Departments have bought into the strategy and action plan.  I know that officials from my Department have been working closely with officials from the Department of Education because of the direct read-across of children and young people who are at school and the impact on their education. I know that work is going on at a practical level, as well as agreement on the strategy and action plan.  Following the passage of the Act in 2011, good cross-departmental work has been going on in respect of autism.

Lifeline

Bronwyn McGahan: 3. Ms McGahan asked the Minister of Health, Social Services and Public Safety to outline any discussions he has with Contact NI and Lifeline staff regarding the proposed changes to the Lifeline service. (AQO 9086/11-16)

Simon Hamilton: I have not held any discussions with the current provider of the service.  The Public Health Agency commissions Lifeline and is undertaking the consultation process on the new service model.  The agency participated in a Contact NI staff workshop on 10 October to outline the proposals and offered to attend a second workshop, which was subsequently cancelled by Contact NI.  Contact NI staff have attended a number of the public consultation workshops organised by the Public Health Agency and have expressed their views at those events.
The proposed model retains the core elements of the existing service, namely the free-to-call crisis telephone helpline, which will be accessible 24 hours a day; qualified helpline operatives who are skilled in talking to people in crisis and have professional skills in listening and in assessing suicide risk; the ability to direct callers to the most appropriate service for their needs; and, finally, follow-on support from locally based suicide prevention organisations, enhanced with complementary therapies and local face-to-face immediate support.
For callers at high risk, helpline staff would directly arrange further care through to emergency mental health services.
By splitting the management of immediate helpline support from follow-up support, the proposals avoid a potential perverse incentive, whereby the helpline provider would potentially gain financially from referring a client to follow-up support that it also delivers.  That does not imply in any way that Contact NI has sought financial gain in that manner.

Bronwyn McGahan: Go raibh maith agat, a LeasCheann Comhairle.  I thank the Minister for his response.  Will he give serious consideration to an extension to the Lifeline contract to allow for further consultation on the future of its services?

Simon Hamilton: There have actually been three offers made of an extension to the existing contract.  Two offers were turned down.  As the Member may know, the contract expires on 31 December.  I am glad to say that the third offer of a contract extension, until the end of September 2016, has been agreed.  Obviously, that allows for continuity of service while we move to a new model of service delivery.

Gordon Lyons: Further to the Minister's answer, can he confirm that a Lifeline service will continue and that this is about the way in which it is delivered and the organisations that deliver it?

Simon Hamilton: Yes, I can.  Again, the nature of the campaign and the way in which it was styled was about protecting Lifeline.  I want to make it absolutely clear — I have done so previously in the House and will do so again now — that the Lifeline service and brand will remain.  As the Member said in his question, this is entirely about getting the best possible service moving forward, getting it better integrated with other emergency services right across the system and extending it out much more into the whole of Northern Ireland, particularly rural areas.  As I mentioned, there is an important governance point about the possible perverse incentive that exists.  On a governance basis, I do not think that that can be allowed to continue to be the case.  The PHA is right to consider that.  Let no one be under any illusion here:  this is not about doing away with a Lifeline service.  This is about how that service might operate and who might operate it.  It is not about doing away with Lifeline and the important work that needs to be done to provide that service for people who are contemplating suicide.

Sandra Overend: Does the Minister accept that the Lifeline service plays a truly invaluable role in every corner of Northern Ireland and that allegations or insinuations of its being a Belfastcentric service are truly inaccurate?

Simon Hamilton: Given that the Member represents a rural constituency, I would think that the issue of rurality is something that she is concerned about and interested in.  Allegations have certainly been put to me about whether it serves the whole of Northern Ireland as well as it perhaps does some bits of it.  If it is a criticism that has been put to me, I think that that is well worth examining, because, as the Member will know, there are sometimes, particularly in rural communities, hidden mental health problems.  There can be suicides.  In my constituency, I know of members of the farming community taking their own life.  We should seek to do the best that we can to ensure that services such as Lifeline are spread right across Northern Ireland.  That is certainly what I want to see as an outcome of the process.  It is certainly something that I will be carefully keeping an eye on as any final recommendation comes to me to sign off on as Minister.  Again, this is about getting the best possible service for people in Northern Ireland.  It is about protecting what is best and also improving the service that can be delivered.

Waiting Lists

Edwin Poots: 4. Mr Poots asked the Minister of Health, Social Services and Public Safety to outline the plans that he has to address the pressures on waiting lists. (AQO 9087/11-16)

Simon Hamilton: I have indicated consistently over the past weeks and months that immediate pressures surrounding waiting lists and our emergency departments can be resolved only with the injection of funding as quickly as possible.
The Health and Social Care Board and trusts are already putting in place plans should additional funding become available, and that will, of course, be focused on patients with the greatest clinical need.  However, even with additional funding, there are limits to what the system can deliver before the end of the year.
For the longer term, I have asked the board to examine how we can deal with demand and stabilise waiting times to put them on a more sustainable footing over the next few years.  That elective care work will set out what areas need to be stabilised, how and when that can be achieved, and what it will cost to get performance back to the nine, nine and 13-week positions that the health service previously achieved.  I expect to receive the conclusions of that work soon.
Of course, it is a great frustration to me that we have wasted close to £200 million of taxpayers' money during the last three years in penalties because of the continued failure to implement welfare reform.  That has affected thousands of vulnerable people who have not been able to obtain the operations that they desperately need.  Every month, we are losing £9·5 million, which could pay for over 1,800 hip operations or 2,100 knee operations.

Roy Beggs: That ends the period for listed questions.  We will now move on to topical questions.

Daisy Hill Hospital:  Emergency Department

Megan Fearon: T1. Ms Fearon asked the Minister of Health, Social Services and Public Safety to do all in his power to protect the Daisy Hill Hospital emergency department (ED), given that she cannot underestimate the importance of a fully functioning, 24/7 ED, particularly for rural communities such as hers. (AQT 3131/11-16)

Simon Hamilton: I am aware of the issue that the Member raises.  I have spoken to her colleague Mr Murphy about this.  I have no desire to see emergency services reduced at Daisy Hill Hospital but, as the Member will appreciate, my priority will always be to try to ensure the highest possible levels of quality and safety in our health and social care services.
I know, and the Member will appreciate, that there have been issues around recruitment and retention in the emergency department at Daisy Hill Hospital.  The trust has undertaken work to alleviate that, but the hospital has been dealt a further blow by the decision of a member of staff to leave early next year.  I know that Members who represent that area, or the area that is covered by Daisy Hill Hospital, were informed of that last week.
The letter that went to Members of this House and, perhaps, MPs as well, was right to point out that, in raising this issue, we are right to be concerned.  The letter said:
"While we appreciate the concerns of the local community, we would worry that further speculation over the future of the emergency department will significantly hinder our ability to attract medical staff to help the situation."
The Member appreciates that point and she is right to raise it today, but it is unfortunate that others ran to the press within 24 hours, creating additional problems and doing exactly what they were advised not to do.  If we are to resolve the issue around recruiting and retaining staff at Daisy Hill Hospital, which I want to do, as does the Member and, I am sure, everybody who represents the area and lives there, it is not helped by scaremongering by some in the press.  We should all be trying to collectively work together to address the issues and work with the trust, the board and others to alleviate the problems.

Megan Fearon: Go raibh maith agat.  I thank the Minister for his answer.  This is especially important, given the completely inadequate Ambulance Service cover that there has been in south Armagh.  Recently, the south Armagh first responders were set up as a community innovation to tackle the problem, but the Health Minister needs to bring his own innovation to recruitment, and new and fresh —

Roy Beggs: Can we have a question, please?

Megan Fearon: I am getting there.  To date, his predecessors have failed to tackle the recruitment problem that has been bubbling up in the health service.

Simon Hamilton: It predates my time — both my immediate predecessors are in the House — but work was done to address the overall problems that emergency departments are having with recruitment.  It is a very difficult area to work in.  We all appreciate and understand that, and it can be challenging to recruit sufficient numbers.
I met representatives of the Royal College of Emergency Medicine last week to discuss not specifically the issue at Daisy Hill Hospital but a range of issues.  They welcomed the efforts that had been put in over the last number of years to attract more staff to emergency medicine.  They did not, by any means, conclude that we were out of the woods or that we had solved all the problems.  There were still issues, but I am sure that they would agree that the most important thing is to serve all our people, wherever they are, whether in Newry or Newtownards, and that they have the highest standard of care and safety of care.  I would be irresponsible in my job and would be going against my duty if staff were coming to me and saying that there were issues with patient safety and I did not act on that.
There are issues and challenges at Daisy Hill Hospital, and I am aware of them.  I look to the trusts to work at resolving those issues and I am happy to make my own suggestions if I have them.  Indeed, I am prepared to listen to others who come forward with suggestions.  If the Member or anybody in the House has ideas or suggestions about how we might resolve the issues at Daisy Hill Hospital, I am happy to listen to them.

Donaldson Report:  Recommendations

Ian McCrea: T2. Mr I McCrea asked the Minister of Health, Social Services and Public Safety whether he has had any discussions with Sir Liam Donaldson about the recommendations in his report. (AQT 3132/11-16)

Simon Hamilton: I met Sir Liam Donaldson at a conference that he was in Belfast to speak at last Thursday.  It was organised by the Faculty of Medical Leadership and Management.  He spoke in the morning and I spoke in the afternoon, and I had an opportunity in between to have a brief conversation with him.  I began by welcoming his positive response to the reforms that I put forward in my speech in Ballymena almost a fortnight ago.
Obviously, he gave some comment to the media as well, about which I responded to Mr McGimpsey.  I think that Sir Liam has been incredibly positive in his response.  The report he produced was very useful, and, whilst I do not think that all of us will have agreed 100% with everything he suggested in it, I welcome the fact that he has acknowledged that the spirit of what he was putting forward has been agreed and taken forward in the proposals that I made.  I have had a useful conversation with him, and I have welcomed the comments he made.  I am sure that, given the work he has done here and the interest he has, he will continue to take a keen interest in Northern Ireland, particularly in how we roll out the reforms that I have put forward.

Ian McCrea: Given the reforms that the Minister has put forward, many of which will no doubt bring financial benefits to the health service, can he outline how he sees the speed of this process and how we can get and feel some real change as quickly as possible?

Simon Hamilton: I know that urgent change is required in our health and social care system because of the extent of the looming challenges that we face in health and social care.  We know and have discussed at length today the financial pressures that our budget and, indeed, all budgets in this place are under.  Coupled with that, in health, we have a growing and an ageing population, which presents a series of challenges.  We have a ticking time bomb of unhealthy lifestyles, and even good things like medical and technological advances are putting additional pressures on costs and increasing demand.  I know that urgent action is required.
I put out a road map of reform in the speech I made on getting rid of unnecessary bureaucracy in our system and seeking to configure our hospital services in the most appropriate way to deal with those challenges and give the beneficial outcome of world-class health and social care system to people in Northern Ireland.  That is not easy to do.  It takes time.  I wish that I could make it happen overnight, but I cannot do that.  I do not have the magic ability to do that.  If I could, I would, and I will not take a minute longer to do it than is necessary.
We need to be mindful that there are processes that we need to go through in closing down organisations in the public sector, but, as I said previously, I will make sure that whatever can be done without the need for legislation will be done and will be implemented as quickly as possible.  The work on the panel's recommendations will take longer, and that is why I have said that that might take half a decade or even up to 10 years.  That is work that is very much long term, but, even though it is long term, we cannot lose sight of the need to do it.

Air Ambulance:  Update

Paul Girvan: T3. Mr Girvan asked the Minister of Health, Social Services and Public Safety for an update on the air ambulance service that he announced to the House a few weeks ago. (AQT 3133/11-16)

Simon Hamilton: In September, I was very glad to announce my commitment to introducing an air ambulance service for Northern Ireland.  I think that that announcement has been very well received across Northern Ireland.  I committed to carrying out a consultation.  I hope to be in a position this week to launch that consultation and that it will look at a range of important issues on which it is pivotal that we come to a conclusion in respect of an air ambulance.  Those issues include where it might be based, how it might be funded and to what level it should be staffed with clinical involvement.  There is a range of serious issues beyond the basic commitment to do it that need to be ironed out, and I hope that a consultation can do that.
I encourage everyone with an interest in this to contribute to the consultation, and I am sure that there will be a range of very different views around what it might be.  The important thing is that we realise the vision set out by Dr John Hinds and, indeed, by many of his colleagues that Northern Ireland can sustain an air ambulance service and, indeed, that it needs one.

Paul Girvan: I thank the Minister for his answer, and I appreciate the positive approach that is being taken to this matter.  All politics being local, I am putting forward a good suggestion that the international airport, which is located in my constituency, is the ideal location for such a service.  Does the Minister consider that to be possible?

Some Members: Hear, hear.

Simon Hamilton: There seems to be common accord for that suggestion, even from Members from other constituencies around the Chamber.  I want to leave it to the consultation to look at issues such as where it might be located.  I do not want to make a commitment here or there today.  I might be tempted to say Newtownards airport, actually.  I think that it is incredibly important that, in taking forward such a serious thing which will benefit people in Northern Ireland in the years ahead, we get it right in terms of how it is funded, how it is operated clinically and where it is located.  I do not want to prejudge the consultation.  I acknowledge that there are certain advantages with Aldergrove, given the collocation with the Police Service of Northern Ireland, which has a series of helicopters there.  I am not sure of the exact number, but I know that there is a handful.  There are certain advantages there — good geographical advantages, as well — but I certainly do not want to rule out anywhere.  There may be other considerations as to the total geographical area that a helicopter emergency medical service might cover.  Certainly, your bid for Aldergrove has been heard loudly and clearly.

Mater Hospital:  Consultants

Fra McCann: T4. Mr F McCann asked the Minister of Health, Social Services and Public Safety what he is doing to address the shortage of consultants in the Mater Hospital. (AQT 3134/11-16)

Simon Hamilton: I thought that this issue might come up today because it has obviously developed over the last number of days, so it is the very definition of a topical question.  Much as Ms Fearon raised concerns about consultant cover at Daisy Hill, similar issues have arisen in the emergency department at the Mater Hospital.  As I said to her, my job — indeed, this goes for anybody who holds this post — should be, I believe, to ensure the highest possible levels of quality and safety in our health and social care services.
The Belfast Health and Social Care Trust advised my Department last week of service difficulties at the Mater Hospital emergency department.  As a precautionary measure, in response to concerns raised by senior medical staff about medical cover in the evening and overnight and the management of paediatric patients, the Belfast Trust has instigated short-term measures to ensure that safe, effective arrangements are in place outside normal working hours and to ensure that children needing emergency treatment get that treatment in the most appropriate place.
Belfast Trust emergency departments are managed as a full, joined-up service, and this precautionary measure was implemented on a coordinated basis to ensure continuity of service in Belfast.  Overnight ambulance diverts from the Mater are expected to remain in place as a temporary measure.  Children will be redirected to the nearby Royal Belfast Hospital for Sick Children, which has a dedicated paediatric emergency department, while the Belfast Trust seeks to resolve the concerns identified and recruit senior medical staff.  I made the point to Ms Fearon that, if clinicians come to me and my Department and say that a service being run in the short or longer term is unsafe, I have a duty to listen to them and to act.

Fra McCann: I thank the Minister for his answer.  I accept and appreciate that there are many difficulties in this, but can he assure us that he will do all within his power to try to ensure that consultancy posts are filled to meet the demand in the Mater Hospital?

Simon Hamilton: Absolutely.  I am certainly committed to doing that and to ensuring that the highest quality of care and safety of care can be carried out in the Mater, Daisy Hill or wherever.  I am certainly committed to doing that.  He should acknowledge, as I am sure he does, the challenges with recruitment.  There is much competition inside Northern Ireland, never mind outside it.  I will certainly do my best.
As I mentioned before, I had a conversation last week with the Royal College of Emergency Medicine, which has acknowledged — I hope that I can speak for it — the good work that has been done by my predecessors in trying to recruit more people to emergency medicine.  Certainly, it warned me that there is a risk that some of the things that we talked about today around Daisy Hill and the Mater Hospital may happen, and we need to do our very best to ensure that they do not happen.  I have tried to put in place the appropriate resources, particularly in terms of staff.  I will certainly make a commitment to do all that I can to ensure that the issue in the Mater Hospital is resolved in the short term and is made sustainable in the longer term.

Slieve Roe House, Kilkeel:  Update

Jim Wells: T5. Mr Wells asked the Minister of Health, Social Services and Public Safety for an update on the Southern Trust’s consultation on the future of Slieve Roe House in Kilkeel, given that he will be aware of the concerns. (AQT 3135/11-16)

Simon Hamilton: I thank the Member for his question.  I know that Slieve Roe House in Kilkeel is an issue that he has a deep and long-standing interest in.  As he will know, the recommendation from the trust, which went out to consultation, was that Slieve Roe should close.  However, the board recognises that there are limited alternative options available in the Mourne and Kilkeel area, and it has agreed to reopen it to admissions until alternative options, in particular the proposed 12-unit supported living facility, become available in the spring of 2017.  Those proposals have gone to the board, and they will come to me as Minister to ultimately sign off on.  I will consider a range of factors before making my final decision.
It is worth re-emphasising, if I may, his commitment and that of Minister Poots when he was in post, and which I have reiterated:  if a final decision is taken for closure, no resident in any of the homes that are earmarked for closure will be moved if they do not wish to move.

Assembly Business

Extension of Sitting

Roy Beggs: I have received notification from members of the Business Committee of a motion to extend the sitting past 7.00 pm under Standing Order 10(3A).
Resolved:
That, in accordance with Standing Order 10(3A), the sitting on Monday 16 November 2015 be extended to no later than 9.00 pm. — [Ms Ruane.]

Roy Beggs: Can I ask you to take your ease for a few minutes, please?
(Mr Deputy Speaker [Mr Dallat] in the Chair)

Private Members' Business

Human Transplantation Bill:  Second Stage

Debate resumed on motion:
That the Second Stage of the Human Transplantation Bill [NIA 64/11-16] be agreed. — [Mrs Dobson.]

Stewart Dickson: First, I thank Mrs Dobson for bringing the Bill to the House today and for the tremendous work that she has done in preparation for what is a very difficult and emotional subject for her personally, and which is also of great importance to many people who have had to face the trauma of a transplant or, indeed, make the decision with a loved one that donation is the appropriate thing that they wish to do when death occurs or, as is the situation now, where many people will make live donations for kidney transplants.
I want to be very brief and say a few things about this issue.  The Alliance Party is supportive of the Bill.  We will listen in detail to the work done in the Committee and follow its progress with interest, but, in broad principle terms, we are very supportive of the Bill as proposed.  I will refer to a number of personal experiences that have taken me to the conclusion that this Bill is of benefit and should be encouraged.
Over 20 years ago, I remember two young men from my constituency who, coincidentally, knew each other through youth activities and the Boys' Brigade, one from Carrickfergus and one from Greenisland.  They were two very early recipients of heart transplants at Harefield Hospital.  Sadly, in time, both of them died, but both were brave in the operation that they faced and both had an extension to their lives that would not have been granted to them had their illnesses continued.  I have no doubt that, as their families look back on what they did at that time, they will realise that they made an immense contribution not only to their lives but to medical science and to the team that was working at Harefield Hospital.
I also want to refer to a friend who has now received the second kidney transplant of his lifetime and to attest to the life-giving powers that that has brought to someone who is in their working years; is fit and able to return to work and to make a contribution to this society and community, and is able be a taxpayer and not a burden on our health service as he is fully fit and able to make a contribution.
I encourage anyone who today wishes to be an organ donor to give serious consideration to that.  I carry a donor card with me.  I have given consent on my driving licence application form just in case anybody is not sure what the card in my wallet is for or it cannot be found, and I have told my family and friends that I wish to consent to donation after my death, if that is appropriate.  As Mrs Dobson pointed out, there are many circumstances where, sadly, it is not appropriate.  A small number of people can become donors.  For those who actively do not wish to be donors, I believe that the soft opt-out is the right approach.  No one will be forced into making a donation.  Family members should not feel under pressure.  It should be a decision made at a particular time and one that the donor should hopefully have given consideration to, but, nevertheless, families and close relatives will have a final say.
I am delighted to support Mrs Dobson in the work that she has done and in the research that she has undertaken, which has been meticulous.  She has consulted widely, and the consultation has, I think, delivered a very clear message to the Assembly.  I have no doubt that the Welsh model, which is one that is proposed, carries a great deal of merit.  I encourage the House to unite today in support of the motion.

Gary Middleton: I, too, welcome the opportunity to speak on the Human Transplantation Bill this afternoon.  Around the world, organ donation policies vary greatly.  There are arguments for and against whether an opt-in donation system, like the one we currently have, or an opt-out system, which exists in other countries, is better.  With the current opt-in system, people have to actively sign the organ donation register to donate their organs after death, and, of course, with the opt-out system, organ donation will occur automatically unless a specific request is made before death for organs not to be taken.  Whilst I have no doubt that there are positives and negatives with both systems, the fact that both are reliant on active decisions from individuals can lead to drawbacks.  Inaction in an opt-in system can lead to individuals who want to donate their organs not donating.  In contrast, the inaction in an opt-out system can potentially lead to an individual who does not want to donate becoming a donor.  There are numerous reasons why people may not act, whether it be through lack of awareness, because of loss aversion or because of a belief that the policymakers have got it right and that there is no need to do anything.
Whilst I have opted in for organ donation by signing the register, it is only when I hear the personal stories of those who are waiting for an organ transplant or those who have received an organ that it truly hits home how life-changing and life-saving the decision is.  One such story that I wish to touch on today is that of Andrew Duncan.  At the age of 23, Andrew was diagnosed with a hereditary condition called dilated cardiomyopathy.  Andrew lived in the Waterside area of the Foyle constituency, in which I reside, with his wife and two children.  He had been on the waiting list for a heart transplant since 2011.  Andrew was a strong advocate in principle for the new legislation on the opt-out system for organ donation in Northern Ireland.  Even though he suffered from a heart condition that made it difficult for him to walk, last February, he carried out a sponsored walk to raise awareness and to raise money for the British Heart Foundation.
He made a poignant video for the British Heart Foundation, appealing for people to consider donating their organs.  I encourage anybody who has not yet signed the register to watch Andy's video.  Sadly, one year ago to this very day, Andrew's time ran out, and he lost his fight for life.  My sympathies today go to his wife, family and friends.  There is no doubt that many others out there have lost loved ones.
As we debate the Bill, it is impossible to ignore the personal stories and those who have been directly affected by organ failure and are reliant on organ donation, just like Andrew.  Although it is important to listen to personal stories, we should not let emotion dictate the legislation.
With nine out of 10 people in the UK saying that they support organ donation, and only three out of 10 having signed the organ donation register, more needs to be done.  I support the elements of the Bill that ensure that the Department of Health further promote transplantation, in particular that it carry out a public campaign at least once a year.
However, a report on organ donation systems by Professor Eamonn Ferguson of the University of Nottingham, noted that countries that used opt-out consent still experienced organ donor shortages.  Completely changing the system of consent was therefore unlikely to solve such a problem.  The report suggested that consent legislation or adopting aspects of the Spanish model could be ways of improving donor rates.
Spain currently has the highest organ donation rate in the world.  The Spanish utilise opt-out consent, but their success is accredited by experts to measures such as a transplant coordination network that works locally and nationally and improving the quality of public information available about organ donation.
More thorough research is needed on the use of the opt-out system, particularly the soft opt-out system that is going through in Wales, which we hope to relate to closely when looking at the Bill.  I expect that we will be able to learn from Wales's experience and use it to carefully consider the future of organ donation in Northern Ireland.  It is vital that we hear further on this very important matter from clinicians and health professionals.
As was made clear from the consultation on the Bill, it is vital that safeguards be put in place to protect children and young people, vulnerable adults, those whose identity is unknown and those who are not normally resident in Northern Ireland.  The report 'The potential impact of an opt out system for organ donation in the UK' stated that data protection and privacy were of concern to many individuals.  Assurances need to be in place for members of the public who feel concerned about the security of key pieces of personal information.
The report also stated:
"An opt out system has the potential to erode the trust between clinicians and families at a distressing time.  The concept of a gift freely given is an important one to both donor families and transplant recipients.  The Taskforce feels that an opt out system of consent has the potential to undermine this concept."
Although there are many concerns about the opt-out system, if we can get it to Committee Stage, that will give the Health Committee an opportunity to delve deeper into and scrutinise the Bill and to hear more evidence.

Rosaleen McCorley: Go raibh maith agat, a LeasCheann Comhairle.  Cuirim fáilte roimh an deis labhairt ar an rún thar a bheith tábhachtach seo inniu.  I welcome the opportunity to speak on this important Bill.
I acknowledge the good work done by Jo-Anne Dobson in bringing about the Bill.  It has been comprehensive, with lots and lots of hard, in-depth work, and it has raised awareness of the subject.  It is an emotive subject, as we have heard from most Members.  That is naturally so, because it involves lives, and lives are being lost because we do not have enough organ donors.
We have the opt-in system that allows people to opt in to be an organ donor.  The soft opt-out way that is proposed is the right way to go, as it will allow for more opportunities for organ donation for people in difficult circumstances.  The circumstances for everyone involved are extremely difficult.

Alastair Ross: I thank the Member for giving way.  I have heard from a number of Members that moving to a system of opt-out will produce more organs available for transplant.  Will the Member tell us where she gets the evidence for that?  The evidence from around the world is incredibly sketchy and there are many areas that operate systems of opt-out which produce a much lower level of organ donation than we have in the UK or Northern Ireland.

Rosaleen McCorley: I thank the Member for his intervention.  He has made it quite a few times today and it has been responded to.  Jo-Anne Dobson made a good response to it, so I am not going to add anything further.  I believe that more lives will be saved and prolonged if we adopt a new soft opt-out system.
As I was saying, it is an emotive and painful issue.  It comes at a time in people's lives when hard decisions are made very difficult.  We must try to make the circumstances easier for people to deal with.  There are no more compelling arguments than the stories that we have heard today.  At Committee, we also heard from people who have had real-life experience of organ donation, what it has meant for them and how it has made such a difference to their lives.  I acknowledge the difficulties and the fact that lots of different views pertain on the subject.  We will work through all the difficulties, hopefully, if the Bill proceeds to Committee Stage.
On average, 15 people die while on the waiting list; that statistic was referred to earlier.  We need to bear in mind that, maybe, that does not need to happen.  As I said, given the opportunity, we will reflect very carefully on the implications of the Bill, and I hope that Members of the Assembly see fit to give it full support.
Before I finish, I will make one last point.  It is important that we take responsibility for having conversations with our families and friends so that people know our wishes.  The more we can do that and the more we can discuss the subject, the easier it will be in times when difficult circumstances arise.

Pam Cameron: I rise as a member of the Health Committee and as someone whose name is on the organ donor register.  I would like to pay tribute to Mrs Dobson for her work in raising the profile of this important issue and for ensuring that there has been considerable public attention and media coverage, which can only raise awareness further.  That is to be welcomed.
Before I turn to specific aspects of the Bill, I would like to make some general remarks on the subject of organ donation.  Although I have not had the personal experience of the Member, I am equally as passionate about the subject and believe that it is critical to raise awareness and provide the public with as much information and support as possible.  There are some truly amazing stories — we heard some today — of lives saved thanks to the generosity of individuals who made the decision to donate their organs.  It is also amazing to see that the families of those tragically left behind after the death of a family member are able to gain at least some comfort from the fact that other lives have been saved or improved as a result of organs donated by their loved one.
For all the stories of courage, love and human kindness, organ donation remains an area that still has enough issues around it to merit further debate and action.  I am pleased that this debate brings that opportunity to the House and to take part in it.  I spent a number of hours at Committee evidence sessions and took further time over the weekend to read through the draft Bill and its supporting material in more depth.  After doing so, I have some questions as I seek further clarification on certain matters.  I have real concerns with regard to the Bill, but I will reserve judgement on it until I have heard the full debate.
The main problem that I have with the content of the Bill is that it appears to be a Bill of assumptions.  Let me just give one or two examples of what I mean.  The Bill assumes that no family member would go against the wishes of any potential donor and offers the use of advocates to ensure that the donor's wishes are adhered to.
I simply do not accept that this can be taken as given.  Families will be in turmoil and possibly not even in the right state of mind due to the magnitude of their loss.  How can a clinician be expected to oversee the practical outworkings of this?  Will families be expelled from the bedside if they do not wish the donation to take place, with only advocates being present when arrangements for donation are being made?  It seems unfair to me to place additional burdens on already overworked clinicians.
I give the example of someone who has expressed their wish to donate.  They have two advocates in place, neither of whom is the next of kin.  The donor has obviously placed their trust in these advocates to back up their wish, and we are assuming that it is for organ donation.  The next of kin, however — possibly a husband, wife or partner — is absolutely opposed and devastated at the thought of their loved-one's organs being donated.  My question is this:  how will clinicians be able to deal with this at the hospital bedside?
The Bill assumes that an annual awareness campaign can be funded and will be pivotal in raising donation figures.  Again, much as I think that the idea is sound, we all know that there simply are not the resources available for every awareness campaign that we might want.  Even if funding were available for this type of campaign, which, incidentally, I am very supportive of, as it is how we will get more names on the organ donor register and prompt more families to have the conversation, we cannot even be sure that an organ donation campaign would be amongst the top health priorities in Northern Ireland, given the many competing pressures on our health service at any given time.
The Bill assumes that soft opt-out and state ownership of organs will be acceptable to everyone and will become a societal norm.  No matter how much I would like there to be no shortage of organs for donation, this just does not sit easily with me, and I daresay that I am not the only one.
Whilst the consultation and the accompanying media coverage have heightened awareness of the issue, it was interesting to note in Committee that, according to the PHA survey, which took evidence from a range of clinicians who are actually involved in the process of organ donation, support for presumed consent was lower amongst them.  At the very least, this would be a warning light to me that we need further consultation with the professionals, as opposed to a public consultation on the SurveyMonkey website.
When I look at the time that an individual would have to invest in discussing this with family and in appointing advocates, I wonder why they would not just take a few moments to fill in a donor card, thereby ensuring that their wishes are known in the event of their death.  On balance, I have to say that I am not entirely convinced that a Bill is the way forward on such a highly controversial, sensitive, emotional and, for some, distressing subject.  I am much more comfortable with the agreed aim of both public and clinicians that more effort be put into raising awareness and encouraging discussions in families.
Finally, Dr Courtney, a transplant doctor at the coalface who accompanied Mrs Dobson to a meeting of the Health Committee in October 2013, expressed the view in response to questions that if the legislation were introduced in the wrong way, it could make things worse.  I will leave it at that.  Thank you.

Pat Ramsey: I am delighted to be able to talk in the debate today.  I declare my membership of the all-party group on organ donation.
I have watched with interest over the years the political role that Jo-Anne Dobson has played in, and the passion that she has had for, elevating and promoting organ donation.  Clearly, she has a huge personal interest in it.  I have also noticed the compassion of a mother coming through, as she has tried to ensure that other families in a similar position reach the desired outcome of a transplant that can save the life of their loved one.
The SDLP supported what Jo-Anne Dobson is proposing in her Bill in our manifesto.  It is an important piece of legislation, and I commend Mrs Dobson for bringing it to the House.  I am aware of her hard work, determination and commitment in pushing through this legislation on organ donation.
I have heard other Members talking about it, and I have absolutely no doubt in my mind that this Bill will change lives.  The Bill aims to change organ donation laws, moving from an opt-in to an opt-out system.  I am grateful for the safeguards that the Bill will put in place, with appropriate family safeguards, a requirement for express consent in certain cases and the ability for people to nominate advocates to affirm wishes upon their deaths.  A key provision set out in clause 2 of the Bill is that transplantation activities are lawful only if there is consent.
I welcome the additional duties in the Bill that will ensure that the Department of Health will actively promote and increase awareness of transplantation.  It will also ensure that the Department provides information about transplantation, deemed consent and the role of family and friends.
During the debate, I have been reflecting on the very untimely death, a few months back, of one of my constituents, Lisa Orsi.  Lisa was a young student, 22 years of age, who had graduated and was working as a physiotherapist in a hospital in Singapore.  She went trekking with a number of her friends and died after taking altitude sickness.  I know the family — Dennis, her father and Sharon, her mother — would like me to reflect on their case.  On her death, Lisa was awarded an ambassador role by the Singapore Government because of the level of donations she was able to give.  Around 50 people got some form of donated organs from Lisa as a result of her untimely death.  It was a heartache and a serious trauma for the family, but they took great solace and comfort from, and were proud of, the fact that Lisa was able to give a quality of life back to so many people in Singapore.  That is the basis — a very personal basis — that I am coming from:  knowing the effect and the desired outcome that it will have, not just in saving lives but clearly, in other cases, in improving the quality of life for many people.
In advance of the Bill being brought forward, a comprehensive consultation process was undertaken — almost 1,300 responses.  We cannot ignore that.   People can question the validity of this or that aspect of the Bill, but the whole purpose of this Second Stage is to enable it to go to the Committee for effective and appropriate scrutiny.  Those Members who have been negative have not just been negative during this debate.  I have seen them having the same negativity at the organ donation group meetings, and not being clear on it.  I think that there is an opportunity —

Alastair Ross: I appreciate the Member giving way.  To provide absolute clarity; when the Member talks about "negativity", that negativity is not about organ donation.  I do not think that I have heard anybody say that they have any problem with organ donation.  Indeed, the aims of the Bill's proposer are laudable ones that we all agree with.  The difficulty is around the method used to arrive at that solution.  There are genuine concerns around the issue of consent.  I think it important to point out that, when the Member talks about negativity, we are not talking about negativity around organ donation; it is about the way in which we deliver the outcome that everybody wants to see.

Pat Ramsey: I did not identify you as being negative, but you have certainly been very challenging.  Those challenges can play a part in the process during the Committee's scrutiny of the Bill in those areas of evidence.  Let the Committee scrutinise; let it find out where there is evidence and where there is lack of evidence.  The important thing is that there is a Bill here that people want to amend.  If people want to look at different areas, then let us hear their ideas.
We have heard that 83% of the respondents that took part in that consultation were supportive.  That is a big majority of that figure of 1,300 people.  The Member is still shaking his head.  I hope, Alastair, that —

Alastair Ross: I thank the Member for giving way on the consultation.  That consultation, which Members have also seen, is from the PHA.  That consultation is, I think, much more in line with other consultations around the United Kingdom around presumed or deemed consent laws, which indicated that the population is much more evenly split:  around 50%.  What is interesting in the PHA document that Members have had sight of, and hopefully, particularly Health Committee members have had sight of, is that it shows that the more that people learn about the system of deemed consent, the less likely they are to support it.
Is he not concerned about that, and does he not recognise the PHA consultation as opposed to the consultation carried out by Mrs Dobson?

Pat Ramsey: The Member has certainly been very articulate about his reasons. He has justifiable reasons, some of them, may I add, very fundamental.  I do not accept that —

Michael McGimpsey: Will the Member take a point of information?

Pat Ramsey: Yes.

Michael McGimpsey: I thank Mr Ramsey.  As I understand it, the PHA consultation had a 61% approval; it was not 50:50.

Pat Ramsey: I say to the Member again that there is an opportunity for DUP members of the Health Committee to pose questions and to challenge.  If they have concerns, they can raise those concerns.  Like other Members, I would like to see an opportunity for the Bill, and I believe that it is a good Bill.  As Jo-Anne Dobson outlined very clearly and admirably, it will save lives.  The Member persists in shaking his head, but anyway.
For many families, it is difficult to discuss an untimely death, even with those who are very close to it.  I referred to Sharon and Dennis Orsi: they took pride, at their daughter's death, in the fact that she was able to invigorate and give life back to so many people in Singapore.  I see the same happening here if the Bill progresses.  The increased awareness and discussion coming out of this is very helpful, as it will encourage and stimulate debate among the medical fraternity and clinicians.  Alastair, you have been in some of the meetings where we had senior clinicians voicing their clear support in Northern Ireland for the Bill.
The family safeguards in the Bill will ensure that families are more involved in organ transplantation, unless the person himself or herself has expressly chosen to opt out.  Locally, under the current system, 30% of the population are registered, despite the fact that UK-wide surveys have shown that 90% of individuals are willing to donate organs.  At the end of September this year, there were 162 patients in Northern Ireland on the transplant list.  I hope that, if the Bill passes, the number of transplants will seriously increase, as Jo-Anne Dobson outlined, and I have no doubt that it will.  Lives will be saved.
I will take personal and political pleasure in supporting the Bill's passage to the Committee.  I say to Members across the way that they should give it a chance.  Nothing will happen.  It will go through Committee, and there may be areas of it that the DUP wants to amend or feels should be changed. Have any of you met Jo-Anne Dobson to personally go through it to see what areas, doubts or concerns there are?  That is the challenge.  I encourage you to talk to Jo-Anne Dobson and her advisers, get an insight into where she is coming from, and maybe we can progress things a lot better.  I certainly support the Bill.

Daithí McKay: I support the principles of the Bill and support its passage to Committee Stage, because it is about saving lives.  The Welsh Assembly realised that: their Health Minister said, quite simply, that it would give hope to people on the register.  This is a soft opt-out system.  We do not want to see a system that in any way adds to a family's grief, but paramount is the need to offer hope to those people and to protect a person's wish to donate.
At present, there are over 650,000 people on the organ donation register, but, as Mr Donald Cairnduff told the Committee, many of them have not told their loved ones or their families.  In many cases, they do not wish to have that conversation and would feel uncomfortable doing so, so we need to see a culture change as well.  Where it has been introduced in other countries, culture change has soon followed.
The Committee discussed scenarios such as where a next of kin opposed donation, even against the deceased's wishes. In such cases, it is important that the wishes of the donor are protected.
With the introduction of the system in Wales, people have a better chance.  If we have a soft opt-out here, people will have a better chance.  Those in need of a successful transplant need to be given a better chance of life: in essence, that is what we are talking about.  By passing the Bill, without or without amendments, we can give people a better chance of life.
The way that I see it, the Bill is one of the most important Bills in the lifetime of this Assembly.  That is the magnitude of what we are talking about.  I congratulate the sponsor of the Bill for bringing it forward.  She has obviously invested a lot of time and effort, and, as someone who has brought forward two private Member's Bills, I can certainly understand the frustration when a Bill is killed off at Second Stage without getting a fair hearing. In that context, supporting the Bill is simply the right thing to do.  The evidence is overwhelming.  On the whole, when variables are accounted for, countries with a soft opt-out have 30% higher donation rates than those that are described as informed consent countries.  The Westminster Government commissioned research by the York group.  It concluded that the available evidence suggested that presumed consent was associated with increased organ donation rates, even when other factors were accounted for.
It is a simple decision for me.  We are debating the broad principles of the Bill, and Members are in agreement with those broad principles.  They may want to make amendments at a later stage, but they should not try to kill the Bill at this stage without giving the opportunity for it to be discussed at Committee Stage.  I reiterate: lives are at stake.  Members will have an opportunity, if they want, to vote the Bill down at Final Stage, but, at this stage, the proper and mature thing to do is to allow it to proceed to Committee Stage, so that we can look at the issues and concerns that all Members and some parties may have with the Bill.
As far as I am concerned, the evidence that I have seen shows that the Bill will save lives.  The introduction of a soft opt-out system has saved lives in other countries.  I believe that it is a no-brainer and should be supported by Members. I look forward to Committee Stage.  We need to look at experiences elsewhere.  We need to look at the Welsh experience, given that they have just come through the introduction of legislation.  Given the size of Wales in comparison with this part of Ireland, it is only proper that we look at the Welsh experience, and then we can look at amendments.  At this stage, we are only discussing the principles of the Bill.  Given its importance to people who are worried about their lives, it is a simple decision to support the Bill at Second Stage.

Alastair Ross: I welcome the opportunity to contribute to the debate.  The Bill has been a long time coming.  We have had debates over the last number of years about its general themes.  I have expressed my concerns about it, and I still have the same concerns. Whilst I remain of the view that legislating in the area is unnecessary and potentially counterproductive, I, of course, recognise that getting legislation to the Floor is, in itself, no easy task. Therefore, I genuinely congratulate Mrs Dobson on all her efforts over the last number of years to raise public awareness of organ donation.
The truth is that, until four or five years ago, many people in Northern Ireland probably did not think about organ donation, let alone have a conversation with their loved ones or families about their wishes for when they died.  I listened to the opening arguments from Mrs Dobson, and it was clear that, as a mother and a campaigner, she is incredibly passionate about organ donation.  She made a powerful emotional argument about why, in her view, the Bill should be passed.
I heard other Members give equally powerful and emotional testimonies from their own constituency and about people in their constituency who have benefited from organ donation.  I have spoken to many families who have had loved ones sadly pass away but were able to save up to six or seven other lives because of the fact that they were organ donors.  It is hard not to recognise the powerful nature of those arguments.
However, I gently remind and appeal to the House that, as well as being mothers or fathers, brothers or sisters and sons or daughters, we are legislators.  It is our job to look at legislative proposals and scrutinise them in depth.  We must look at evidence from elsewhere in the world and not get carried away with the emotional argument, because it is important that we fulfil our role as legislators.
I am also quite sure that the amount of media attention around the proposals in the Bill will have prompted people to have the conversations that I mentioned and let their loved ones know what their wishes are.  I think that it is something with which everyone in the House and outside it with an interest in organ donation will agree on:  that the most important thing that we can all do is discuss with our family what our wishes are for when we die.  If I have learnt one thing over the past number of years from taking a particular interest in this area, it is that what we want in our system is certainty and clarity when it comes to organ donation.
In my view, the only sure way of achieving that clarity and certainty is to make an informed decision during our life and to share that decision with our loved ones.  That makes decisions that are ultimately taken by our surviving relatives easier in what are almost always incredibly difficult circumstances.  As I have said on many occasions before, and I will say again to the House, one of my real concerns about passing a Bill of this nature is that we will have less rather than more certainty in the system.
Consider a family being called to a trauma unit in a hospital following a tragic accident involving a loved one.  It could be a family that have never discussed organ donation and have no idea about the wishes of their loved ones.  Under the Bill, that individual would be considered in law a willing organ donor, even when he or she has not been asked or never considered the issue.

Jim Wells: Will the Member give way?

Alastair Ross: Go on.

Jim Wells: The Member is making valid points, but is he telling me that he is going to vote against the Bill moving into Committee, where many of his concerns can be addressed and the arguments teased out?  Is he advocating that we vote against the principle of the Bill going to Committee or saying, "Take it to Committee and consider the points that I am raising"?

Alastair Ross: The Member makes an interesting contribution.  Other Members have raised the point about the importance of letting the Bill go to Committee Stage for it to be investigated further.  I view the principle of the Bill, and Second Stage is about a Bill's principles.  The principle of the Bill is not the importance of organ donation.  The principle of the Bill is introducing an opt-out system — a presumed consent system, or a deemed consent system — for Northern Ireland.  On that basis, I am opposed to the principle of introducing law to make presumed consent the reality in Northern Ireland.  On that basis, yes, I am opposed to supporting the Bill at Second Stage.
I accept that I am very much in the minority.  However, that will not stop me advocating my own concerns around the issue.  I genuinely hold the belief that Second Stage is about principles, and the principle of the Bill is presumed consent.

Jo-Anne Dobson: I thank the Member for giving way.  I just remind him that my door remains open, as it has been since I first proposed the Bill.  I have corresponded via email, and I am still waiting for the Member to take up the offer to come and meet me.  I also remind him that, in a radio interview on Frank Mitchell's show last year or the year before, you reiterated the fact that, if a family affirmation were in the Bill, you would have no concerns about it.  What has changed since then?

Alastair Ross: That is not my position, and I challenge the Member to find a transcript of any radio interview in which I said that.  We did try to have a meeting.  As I recall, a number of dates were provided, and none was suitable to the Member to meet.  Let me make the point to her, and this is not in any way an attack on Mrs Dobson, but she is intent on introducing a system of presumed consent for organ donation in Northern Ireland.  I am absolutely opposed to introducing a system of presumed consent.  Therefore, in my view, there is nothing in clause 4 that would be bettered through amendment, because you would be going against the very principle of the Bill.

Jo-Anne Dobson: I thank the Member for giving way.  Where does it say "presumed consent"?  It is deemed consent with family affirmation.

Alastair Ross: Presumed consent and deemed consent is exactly the same thing.  In law, it is exactly the same thing.  I listened to the Member and some of her supporters say that the Bill would not have deemed consent or presumed consent.  It does have deemed consent, which is presumed consent, and everybody, I think, acknowledges that.  Other Members have used that phrase as well.
I will try to make some progress.  I support organ donation — hopefully I have articulated those views — and I think everybody does.  However, I think that there are ethical and moral issues around this Bill.  Moving towards a system of presumed consent will put more pressure on families and medical staff in what are already incredibly difficult circumstances.  I do not want a situation where families will feel pressured into allowing donation to proceed in those circumstances.  I raised the issue of consent with a number of Members, and how the absence of an objection from the individual concerned can never be considered the same as actual consent, and they have not given me a good answer on that issue.
Just as I commend Mrs Dobson for provoking a public debate on organ donation, some of the media coverage generated around the issue has been incredibly disappointing.  Not only is much of it incorrect, ill-informed and sensationalist, but it has not, in my view, provided a balanced coverage for what is, as Members have acknowledged, an extremely sensitive and potentially controversial issue.  To quote one example, on 12 February last year, the editor of the 'Belfast Telegraph' wrote:
"To allow even one person to die through needless delay in the passage of this Bill would be an indelible stain on the Executive's legislative record."
It is very difficult to have a rational debate in the circumstances in which those of us who oppose presumed consent or deemed consent are accused of not wanting to save lives or worse — of actively wanting people to die.

Steven Agnew: I thank the Member for giving way.  I am trying to get to the crux of the objection.  He speaks of a moral and an ethical objection.  Is it his contention that the evidence suggests that it will not increase organ donation?  My analysis of the evidence is that it will.  Or is it that he believes that the end does not justify the means — that it will increase donation, but there is a moral argument against doing it?

Alastair Ross: I appeal to the Member to be patient, because I will articulate my arguments against the Bill for both reasons; first, because I do not believe that the evidence suggests that it will work; and, secondly, even if it did work, I think that there are real ethical questions around the consent issue.  However, I will articulate those in more detail.  If the Member wants to make an intervention at that stage, I will be more than happy to allow him to do that.
As I said with regard to some of the public statements on this, I think that no responsible person should call for important legislation of this nature to be rushed through without it being thoroughly scrutinised and considered, because that is, after all, our job.  In her opening comments, Mrs Dobson appealed for us to rise above petty political posturing or party politics.  She did that after reading out a series of comments from party manifestos.  In my view, this is not a political issue; it is a personal issue.  I certainly have not stood on any Assembly manifesto supporting presumed consent, and my colleagues in the Assembly have not either.  T
here are stark differences of opinion and different views on the issue.  There are different views within the Democratic Unionist Party, and we have a free vote on the matter.  Therefore, I found it particularly odd that people accused me of playing party politics with the issue, when some of my colleagues are very supportive of Mrs Dobson's Bill.  In fact, the keenest supporter is Mr Jim Shannon, who is the Member of Parliament for Strangford.  Mr Shannon and I have had many arguments over the merits or lack of merits of moving towards the position of presumed consent.  This is not a political issue for me.  I really despair at times when Members try to raise that issue, because, in my view, it is not a party political issue.
Given that it is a controversial issue, it is perhaps unfortunate that it is being introduced so late in the mandate, when the Health Committee could have a particularly heavy legislative workload.  I noted the comments that Mrs Dobson made during the Second Stage debate on the Mental Capacity Bill on 16 June when she recognised the difficulty of introducing legislation so late in the mandate.
She said of that Bill:
"the Bill faces a challenging legislative timescale. As the Chair of the Ad Hoc Committee has already said, the problem with passing it through the House at the latter end of the term is that it will inevitably get caught up in a raft of other Bills, especially after the summer recess. Whilst I think that the Ad Hoc Committee will be able to perform its role, it is regrettable that the Assembly more generally will have less opportunity to examine this important legislation than it would have had if the Bill had been introduced a year or even six months ago." — [Official Report, Vol 105, No 7, p21, col 2].
I agree with her.  In my view, this Bill is not simple or uncontroversial legislation.  I say that not because I want to embarrass Mrs Dobson but because she highlighted an important issue on the complexity and challenging circumstances of the Mental Capacity Bill.  Equally, this Bill needs a lot of scrutiny and attention, and I am not sure that towards the end of the mandate we will be in a position to do that.

Jo-Anne Dobson: Will the Member give way?

Alastair Ross: Certainly.

Jo-Anne Dobson: Maybe the Member can give us an update, following consultation, on the position of his Bill.

Alastair Ross: I went out to consult on a different way of boosting organ donation.  After consulting medical clinicians, my view is, very simply, that legislation is not required to boost the number of organ donors.  Therefore, I did not bring legislation forward.  The Member or any other Member should know by this stage that I am not particularly keen on legislating if it is not necessary.  Sometimes, we legislate far too much.
I spoke to clinicians and experts on organ donation, and the view was quite clear: they did not feel that legislation was required.  If I had reached the position where I felt that legislation was required, the way I was proposing would have been better than presumed consent.  However, legislation is not required —

Jim Wells: Will the Member give way?

Alastair Ross: Mr Wells.

Jim Wells: Had the Member pursued his Bill, would he not have felt aggrieved if the House had decided to block it at Second Reading and not allowed the nuances of what he was trying to say to be teased out in Committee? Does he not see that as a fundamental issue?  He has concerns — they are well articulated — but he is denying the Health Committee an opportunity to tease out his arguments.  If he remains unconvinced, there will be another opportunity at Final Stage to vote against the Bill. He is denying the debate that everyone else believes is required.

Alastair Ross: I have not denied any debate; we are having a debate right now.

David McIlveen: Will the Member give way?

Alastair Ross: I will give way in one second.
Mr Wells has been a Member of the House for much longer than virtually anybody else in the Chamber.  He, more than anybody, should know that the Second Stage debate is about the principles of the Bill.  If you are opposed to the principles of the Bill and it passes through Second Stage, whatever happens with amendments, the same principles will come out at the other end.  You are agreeing to the principles of a Bill.  He shakes his head, but that is the process by which legislation goes through the House.  If you agree with the general principles of the Bill, you can amend certain elements of it, but the fundamental coreof the Bill, which is presumed consent, will come out at the other end.

Jim Wells: Will the Member give way?

Alastair Ross: I am not going to give way again.  Mr McIlveen asked me to give way.

David McIlveen: I thank the Member for giving way.  Does he agree, in relation to the interesting debate that has broken out on the Back Benches, that this is not an issue of tinkering around the edges?  An amendment will not fundamentally fix the issue.  Presumed or deemed consent is one of the foundation stones of the Bill.  Therefore, suggesting that it can be tinkered with around the edges is an argument that would be difficult to stand over for those of us who have concerns.

Alastair Ross: I thank Mr McIlveen.  That is the view that I was trying to articulate to Mr Wells.  I am not trying to deny a debate on any issue.  I hope that there is a healthy debate in the Chamber, because, up until this point, I have not heard much debate.  Hopefully, if we are to fulfil our functions correctly, we will have that debate. There are genuine concerns about moving towards a position of presumed consent, not just from me and some of my colleagues and not just from ordinary members of the public but from clinicians and medical professionals.
A number of the clinicians who work closest to transplants have expressed their unease about changing the legal parameters in relation to organ donation.  That is recognised in the PHA public consultation document, which showed clearly that, the closer you got to clinicians who work with potential donors, families of donors and patients, the less likely they were to support changing to a system of presumed or deemed consent in an opt-out system. The same PHA report indicated that the more people understood about deemed consent, the less likely they were to support it.  Suddenly, the figure of 90% for the people who, we often hear, support organ donation drops to around 50% for those who support a system of presumed or deemed consent.
I listened to Mr McGimpsey saying that around 60% of people supported presumed consent.  That was during the first question.  The PHA report shows that, once they learnt more about what presumed consent was, that figure dropped to one that is more evenly balanced.  That is something that we should certainly take cognisance of.  When considering the views of donor families, the PHA document shows that there was no clear consensus on whether they would prefer an opt-in or opt-out system.
As I have said on numerous occasions already during my contribution, the role of the Chamber is to scrutinise legislation, to examine the impact and potential unintended consequences and to use evidence to decide on whether legislation is desirable or required.  Having considered the issue in some depth over the last number of years, I hold the firm view that changing the legal framework from the current voluntary opt-in system for organ donation and enacting legislation such as is in front of us today creates confusion for families rather than certainty, is not proven to work and is wholly unnecessary to promote and boost the level of organ donation here in Northern Ireland.
Before addressing some of my concerns in detail, let me say again, as I said at the beginning, that I support organ donation.  I said that to Mr Ramsey.  I agree with the goal that Mrs Dobson has, namely increasing public awareness and increasing the number of organs available for transplant.  I simply disagree on how we get there.  Presumed consent or deemed consent, as it is labelled in the Bill, is a legislative framework in which all adults living in this jurisdiction will be considered to be willing organ donors unless they actively opt out by joining a register.  That changes the default position.  By passing the Bill, the 108 Members in the Chamber would effectively decide that everyone in Northern Ireland wants to donate their organs upon death, without ever asking them.  I do not believe that we have the moral authority to make that choice for people.  I strongly believe that we should make it easier for people to make their own choice about what happens to their body when they die and that we should absolutely not try to make that decision for them.
My principal opposition to the Bill is around consent.  I will examine that in greater detail later.  We should also use the evidence available to us to consider whether legislation is required at all.  To do that, we must first determine whether we have a problem in Northern Ireland to solve and, secondly, ask whether this type of legislation will solve it.  Only after examining those two issues should we consider whether the proposed legislation would be legally, ethically or morally sound.
Let us look at the current state of play in Northern Ireland.  We have a reasonably good story to tell, as was acknowledged by the Minister on a recent visit to one of the Belfast hospitals.  In Northern Ireland, we have a rate of 26·2% for transplants from donors, which is a higher donation rate than in many of the places in Europe that currently operate systems of presumed consent when we consider donations from those who have passed away. Sweden has a rate of 17·1%; Austria's rate is 25·5%; and the much-lauded Belgium, which is globally recognised as a good example of organ donation, has a rate of 26·8%.  That is reasonably comparable to what we have in Northern Ireland, which would, in European terms, be the fifth highest rate.  Furthermore, Northern Ireland consistently has one of the highest living donation rates anywhere in Europe.  With a rate of 32·8%, we can celebrate the bravery and generosity of those in Northern Ireland who go through surgery to donate organs to those who need them most.  That is higher than in Sweden at 16·2% and Austria at 9·1% and much higher than the much-touted Spain, where the rate is 9·9%.  When considered on a global level, Northern Ireland would be third on the table for living donor rates, as is shown by the International Registry in Organ Donation and Transplantation.  
From considering the number of organs that are gifted by those in Northern Ireland it is clear that we have some of the most generous people in the United Kingdom.  The net gifting of organs in Northern Ireland is of a negative number for every major organ donated, meaning that we take less than we give to the national organ transplant pool.  Some of the stats were read out by Mrs Dobson for the number of organs, whether it be liver, lung, heart or pancreas, that we donate and the few that we get back.  It is important to note that not every heart will be suitable for every person waiting for a transplant.  Sometimes, unfortunately, the individual does not take to the organ that they receive.  It is not simply an arbitrary argument over numbers.  Nevertheless, the numbers in Northern Ireland should be celebrated, although, of course, there is more to be done.
We should be applauded for the efforts that we have made in recent years to boost organ donation, but, of course, as other Members have said, that will be of little comfort to those waiting for a transplant who cannot get one.
So there is an argument that, even though we have had a relatively positive story to tell, more should, and could, be done.
Those who support the Bill claim that, by passing it, we will save lives and boost organ donation numbers.  Those, of course, are laudable aims, but, as I have said, evidence from around the world suggests that deemed consent does not work, and, if it did, there are all kinds of ethical, moral and legal difficulties with the system.
The presumed consent model is not a new one.  It has been tried elsewhere and, most recently, Wales, as has been mentioned, decided that they would introduce presumed consent for organ donation.  Interestingly, there is no established correlation between those countries that operate deemed consent and an increase in organ donation rates.  Sweden, Norway, Brazil and Chile have presumed consent models but have significantly lower rates of organ donation than we do in Northern Ireland.  Indeed, when deemed consent legislation was enacted in Brazil and France, it had the opposite effect to that which was intended, and the rate of organ donation dropped rather than went up.  More importantly, the top two countries in the world for organ donation, the United States of America and Spain, have an opt-in system similar to what we have in the United Kingdom.
I want to spend a little time examining the Spanish case study, because, over the last decade, Spain has consistently had one of the best organ donation rates and the family acceptance rate, the importance of which Mrs Dobson talked about earlier, is an impressive 85%, yet some misinformed commentary on Spain says that they use presumed consent.  The truth of the matter is that Spain does not use presumed consent.  I will quickly refer to an article written by Professor John Fabre, a professor at King's College London.  He goes into some detail about the system that operates in Spain.
He said that Spain has consistently had the world's best donation rate, with around 32 to 35 per million population for more than 10 years, and that its family acceptance rate is an outstanding 85%.  However, Spain does not operate a presumed consent system.  As a result of its pre-eminent international position, advocates of presumed consent very frequently misrepresent Spain out of ignorance or wishful thinking.  Spain passed presumed consent legislation in 1979.  However, the legislation did not have a positive influence on donation and, so, in 1989, crucial organisational changes were instituted at a national level.  These changes created an organisational infrastructure for transplantation, now internationally known as the "Spanish system".  It is that system that the UK has emulated so successfully in recent years.  It is from 1989 that Spain's donation rate began to rise to the pre-eminent position that it currently occupies.  Many observers have wrongly attributed Spain's success to its 1979 presumed consent legislation.  To correct that misconception, the director of the Spanish organ donation organisation, Dr Rafael Matesanz, was co-author of a paper that was published in the 'British Medical Journal' in 2010, which clearly stated that presumed consent law in Spain is dormant.
I think that that is important as we look at the countries that have the best rate and destroying some of the myths that exist around that.  Spain's success is also referred to in a 'British Medical Journal' article written by Linda Wright, a bioethicist from Toronto.  In that document she argues against presumed consent.  She says:
"Presumed consent will not answer the organ shortage. It has not eliminated waiting lists despite evidence that it increased organ donation in some countries.  Systems of opting out do not ensure higher rates of donation than opting-in systems.  Strategies to encourage people to donate and public education seem to help and are independent of whether people have to opt in or out.  The shortage of organs has multiple causes; no single strategy is likely to solve it.".
In particular and specific reference to Spain, Linda Wright goes on to say:
"Other factors that might explain Spain's enviable rates of organ donation include an environment that treats organ donation as a priority.  Transplantation has a strong support system, a dedicated budget, and accountability for performance.  Staff are trained how to approach grieving families about organ donation.  Donation will not increase without the necessary equipment, trained staff, and intensive care beds to enable a potential donor to donate viable organs.  These institutional factors contribute to the donation rate and seem to account for some of the variation in rates of organ availability.".
Again, that is a medical journal arguing against bringing in presumed consent and saying that the main drivers are ones other than an opt-in or opt-out system.
A further interesting article on Spain's organ donation success can be found in a 'Health Law Review' paper of 2010, which explains what worked in Spain and why they have changed their mind on deemed consent.  Again, I will quote from that journal.  It says:
"Spain's rate of ... donation is currently the highest in the world, and has been for some time.  As a result, Spain is often viewed as the country to emulate in this field. ... The Spanish government enacted a presumed consent law in 1979. ... the Spanish organ donation system floundered again through the mid 1980s, plagued with erratic donation rates, lack of infrastructure and administrative inefficiencies."
Echoing the comments that were made by Professor Fabre, this article says:
"The true turning point came in 1989, when the Spanish Ministry of Health set up the National Organization of Transplants (ONT).  The ONT is a national body responsible for administering and coordinating Spain's system.  Shortly after its creation, the ONT reorganized the Spanish system to allow more efficient and greater regional decision making.  The ONT made extensive efforts to put infrastructure and training into place for transplant teams.  These efforts bore tremendous dividends — between 1989 and 2006, Spain's organ donation increased enormously and has remained at a sustained high level for years."
The article goes on to say why it did not support presumed consent.  It says:
"The ONT's primary fear was that trying to enforce the presumed consent law strictly would 'increase grief and would taint the system as coercive, labeling the ONT as an organ hunting device protected by an abusive law.'  This approach appears to have paid dividends".
It goes on to say that, as it is pointed out:
"Spain’s rate of family refusal fell to 21.3% in 1998, representing a drop of almost 30% from refusal rates in the early 1990s.  The authors credit this to significant efforts to overcome various obstacles, including an earlier reluctance to approach grieving families."
The importance of those transplant coordinators cannot be overstated.  In Spain, the data quite clearly suggests that family consent rates are more than doubled when a coordinator in a hospital is able to spend three or more hours with a family.
Of course, the other country with a good record in organ donation is the United States of America.  In the US, the surgeon general introduced new legislation on the US federal register that meant that each hospital had a legal duty to identify and refer every potential donor to the organ donor organisation.  Potential donors are identified using clinical triggers that are very often present in patients who are likely to be diagnosed as brainstem dead.  In addition, the US has a well-staffed and extensive network of organ donor coordinators and systems in place to reimburse hospital costs.
I have referred to the fact that, in the UK, Wales has indeed gone ahead and legislated for deemed consent, although clearly most Members would acknowledge that it is far too early to determine whether it will have any impact.  When Prime Minister Gordon Brown was in office, he was very supportive of moving towards a system of presumed consent.  He indeed commissioned a piece of independent advice from the organ donation task force.  What is interesting about that piece of work is that, although it started from a position of supporting a change in the law on how we donate organs in the UK, the report concluded, however, that the UK should not move away from the current opt-in system.  Let me quote from that report because I think that it is important that we listen to the evidence that was produced by the organ donation task force.  It says:
"When the Taskforce began its deliberations, members had a variety of views.  By the end of the process a clear consensus had been reached, but only after an extensive range of evidence had been considered along the way, with much powerful and well considered opinion expressed on both sides of the equation."
That report goes on to say:
"we found considerable evidence highlighting the potential downside of such a move"
towards deemed consent.  It goes on to say:
"The Clinical Working Group heard persuasive arguments from health professionals about the potentially negative implications for clinical practice, especially the potential to damage the vital relationship of trust between clinicians caring for people at the end of life, their patients and their families.  Some intensive care staff in particular fear that a move to an opt out system would make critical care more difficult and could lead to some intensive care practitioners themselves opting out of participation in donation programmes.  This would be disastrous for the future of organ donation in the UK since many of the recommendations made by the Taskforce in its earlier report, Organs for Transplants, are dependent on the active support of intensive care practitioners."
The report continues:
"The working group considering clinical implications also heard powerful evidence from recipients of organs who stressed their need to know that organs had been freely given by donors and their families, and from donor families who often find great comfort in being an active part of the decision to donate."
It goes on:
"It became increasingly clear that it would be both complex in practical terms and also costly to put in place an opt out system that could command the trust of professionals and members of the public.  There would need to be a significant and sustained communications programme to ensure that all members of society knew about the new system and what it would mean for them.  Real concerns were expressed about the security of information on an opt out register".
The next paragraph states:
"We heard support from members of the public and patients' groups for the principle of informed consent, and a perception that assuming consent from silence belongs to a more paternalistic era.  Some felt that an opt out system could be 'dehumanising'.  Given that current trends in healthcare place great emphasis on choice and responsiveness, this is an important consideration."
Again, that is a point that I tried to make to Members.
The report then states:
"Many people have reservations about a change to an opt out system, including some who are currently on the Organ Donor Register (ODR).  Some faith leaders we spoke to warned of the potential for provoking anti-donation feelings and even active anti-donation campaigning.  We heard considerable concerns about the impact on some groups, for example those who might be less comfortable using the 'opting out' process ... On balance, the Taskforce feels that moving to an opt out system carries a significant risk of making the current situation worse."
Members should read that report by a group of experts that was set up by the then Prime Minister Gordon Brown and digest some of the information that is in there.  As I said to Mr Agnew, even if the evidence from elsewhere in the world were to suggest that an opt-out system, or a deemed consent system, will result in higher levels of organ donation, there would still be questions around whether it is the right thing to do.  I contend that it is probably not.
Earlier, I mentioned the fact that in Brazil deemed consent was introduced to boost the rate of organ donation.  However, in practical terms, the actual rate of donation dropped in Brazil.  That was in part because of a backlash against the state presuming the consent of its citizens and also because of a lack of trust in the medical profession in Brazil.  To document that, I will quote from a 'Health Law Review' of 2010, which talks about the Brazilian experience and states:
"Far less needs to be written about Brazil's attempt at presumed consent.  By way of background, the Brazilian law was passed in 1997, became effective in 1998 and immediately faced heavy criticism."
It continues that it was noted:
"in practice, almost all surgeons sought consent from family members",
and that the presumed consent law was not really used.  It goes on to state:
"Brazil still lacked the necessary infrastructure and administrative effectiveness to take advantage of such a gain.  However the core problem with presumed consent in Brazil was widespread public distrust towards the medical profession ... Popular imagination also played a part in the downfall of the law.  Part of the population feared that their organs would be removed even before they were clinically dead.  Many rushed to public offices to register themselves as non-donors, to avoid such a risk.  Apparently there were even difficulties registering as a non-donor in Brazil, further fuelling the fear that the law was ultimately an attempt at exploitation."
I say that not to be alarmist but to point to the fact that issues around consent are important and that we need to consider them.  Many clinicians in the United Kingdom, and in Northern Ireland specifically, also harbour concerns about the impact that the Bill could have on the doctor-patient relationship and trust in the medical profession, as well as the question of whether it would work.
I noted comments by Dr Declan Grace, who is the lead clinician in charge of organ donation in the Western Trust.  He is one such expert who has publicly come out and said that he has concerns about the Bill.  An article that appeared in the Belfast 'News Letter' on Wednesday 19 February 2014, reported that Dr Grace said:
"he had 'great concerns' about the implications of the suggested changes, fearing that mistrust could be created between medics and patients."
The article went on to state that Dr Grace spoke at a public meeting on the issue and reported that:
"he thought that an opt out system would lead to an 'initial subtle uplift' in the number of people signing the donor register or expressing interest.  But he expressed fears about the long-term implications",
for organ donation.  The article said that he feared that there would be a drop:
"in the number of families giving consent for their loved one's organs to be donated",
and expressed real concerns about moving forward with such a system.
Anyone who has researched this issue and read the comments of or spoken to clinicians working closest to organ donation will have heard this before; it is a common theme.  A survey of Intensive Care Society members in 2008 indicated a belief that the introduction of deemed consent may damage the relationship of trust between clinicians caring for patients at the end of life and their families.
The Alder Hey case exemplifies why the public are uneasy around issues of consent.  For Members who are unfamiliar with Alder Hey, it was a case where doctors took organs from deceased children without parental consent.  Obviously, it caused a public outrage and led to questions for the medical profession about whether it is ethical to take organs without informed and expressed consent from anyone.  I say this not to be sensationalist; I simply refer to it as a case to highlight the sensitivities and fears around failing to establish consent.  Personal autonomy is so important, particularly when it comes to the healthcare system, because it ensures that the individual's views and wishes are respected.  Indeed, many members of the Health Committee are also members of the Ad Hoc Joint Committee on the Mental Capacity Bill and, time and again, we talk about the importance of autonomy of individuals being supported to take decisions and actively making decisions during their lifetime.
It is firmly my view that presumed consent is not consent at all.  Is it legally valid?  How can silence in an opt-out or deemed-consent system be interpreted as actual consent?  It is an issue that I raised with many Members previously in the debate, and I do not think that any of them have given me a satisfactory answer to it.

Steven Agnew: Will the Member give way?

Alastair Ross: Certainly.

Steven Agnew: I may not give him a satisfactory answer, but I will pose a question.  There are many areas in our lives where our consent is deemed.  He may have views on the example of telemarketing.  It is assumed that our phone numbers and addresses are there to be used by marketing companies and, indeed, can be bought unless we opt out through the Telephone Preference Service or the Mailing Preference Service.  That is something that exists in our lives, and it is for profit.  This is an area where we can save people's lives and, given that people accept telemarketing, I am sure that they will be much more favourable towards something as serious as saving people's lives.

Alastair Ross: Let me address the issue of saving people's lives.  If this were clearly determined to save people's lives, I think that we would be having a different debate today.  I contend that this legislation is not the primary driver that can help us to save people's lives through organ donation, and that is one of the reasons why I am opposed to it.  I think confusing the two issues of telemarketing and what happens to our bodies when we die is trivialising the issue somewhat.  I pose this question back to him:  can he point to any area of common or statute law in which silence amounts to consent?  Would anybody argue that there is any other area of medicine or in law where somebody's silence on an issue should be interpreted by law as the same as giving informed consent?  That is one of the areas where I have real concern over this legislation.
I know that Members will try to trivialise this issue and say that I am just opposing it for a variety of other reasons or that I am not interested in saving lives.  I am absolutely interested in saving lives, but I think that we need to do it in an ethical way and, in many cases, the ends do not always justify the means, and the means are equally as important.  I think that, when it comes to what happens to our bodies when we die, we absolutely should be making sure that, during our lives, we make a declaration about what we want to happen because that is how we get certainty into the system.

Jo-Anne Dobson: Will the Member give way?

Alastair Ross: I will give way to Mrs Dobson, although she does not always give way to me.

Jo-Anne Dobson: I thank the Member for giving way.  The Member has raised the issue of silence providing consent numerous times during this debate and has challenged a number of Members to inform him of when silence is assumed as consent in other areas of our health service.  Well, I am going to accept that challenge from him, and I will welcome confirmation from the Minister that there are many areas in the health service where this is the case, including but not limited to additional procedures during surgery, emergency treatment, mental health conditions, self-harm and attempted suicide, and when there is a risk to public health.  However, I have said from the beginning that the family will and should maintain the key role in providing consent following the death of a loved one.

Alastair Ross: I absolutely accept the fact that, as with the current system, her proposals would allow families to effectively veto the donation from happening, but I think that that misses the point.  The first stage is about how we get to arrive at consent, and I have a real difficulty that this House in passing the Bill is saying that we, as 108 legislators, have decided that every adult in Northern Ireland is a willing organ donor, without ever asking them.
That is the concern.  I am not challenging the fact that families will have a veto over it.  What I am challenging is how we get the consent in the first place and whether having silence on the issue will help families make those tough decisions.  I am very much of the view that it will not help families.  If a relative of mine were in a trauma unit and, sadly, was likely to lose their life, of course, I would want to do something that they wanted me to do.  The clearest way that I feel I could get that assurance is from knowing that they made an informed choice during their life to donate their organs.  In those circumstances, I would be more likely to allow the donation to go ahead than if I was not sure.  That is why, again, I have concerns about the Bill.
I have talked about some of the legal and moral difficulties with moving to a system of presumed consent.  Again, I think that it is helpful to look at the Organ Donation Taskforce report, which has a specific section on some of the legal issues.  I will quote directly from the legal working group, which said that it would be concerned about potential successful challenges under European Convention on Human Rights legislation.
It then states:
"Furthermore, the legal group concluded that simply having a register where people could record their decision (opting either in or out) during their lifetime, without involving families at the time of death, would probably be insufficient to ensure compliance with the ECHR because: 
• in an opt out system, it could result in organs being taken from those who had not yet managed to register an objection, perhaps because they were simply busy or disorganised. They might also have learning difficulties or other problems with communication, such as English as a second language".
I recognise that Mrs Dobson is trying to ensure in the Bill that there are certain safeguards around that.  However, I will read out the statement again, because this is where my concern around consent comes from:
"in an opt out system, it could result in organs being taken from those who had not yet managed to register an objection".
The failure to register an objection can never be considered to be the same as giving informed and express consent.  I have raised that issue a number of times, and I will continue to do so, because that is where some of my major concerns come from.

Fearghal McKinney: Will the Member give way?

Alastair Ross: I will.

Fearghal McKinney: I apologise to the Member for not being in for all of his contribution, but I had to be at a number of meetings elsewhere.
During Mrs Dobson's presentation to the House and to the Committee, she reflected on the public awareness campaigns and the fact that significant resources would be directed towards that type of campaign.  Surely that would limit the issues that the Member is raising about those who may not find themselves able to give consent.  Would public awareness campaigns not be able to target the vulnerable or those less able to understand some of the issues as well?

Alastair Ross: The intention of a public awareness campaign should be to try to actively get people to make a decision in an opt-in system.  Indeed, I paid tribute to Mrs Dobson at the beginning of the debate, because we are all much more aware of organ donation in Northern Ireland now than we perhaps were four years ago.  The fact that the media have very much reported on some of her campaigning has meant that families will have those conversations and make decisions, which is a good thing.  I also think that the Department of Health, under various Ministers, should be commended for its public awareness campaign with the PHA in recent years.  If we look at the figures for that campaign, we see that more and more people are joining the organ donation register or are having that conversation with families.
I think that that is a much better system than one where we automatically assume that consent has been given but have to check once a year that people are aware of the system.  I think that that is a dangerous system.  It is a dangerous precedent to create in law or medicine, and there are huge challenges around it.  I want to try to eliminate, rather than limit, confusion.  I think that by moving to a system where we ask people to give informed consent during their lifetime is a much better safeguard in ensuring that families, at a very difficult point in their lives, make decisions that they are confident and comfortable about.
I raised some of the legal concerns about the absence of consent, and I do not think that the intention of those who drafted the Bill is for organs to be taken when that is not the express wish of the individual concerned.  I do not, for one second, say that that is the intention of the drafter of the Bill.  However, as legislators, we need to be alive to these issues and ensure that we study and scrutinise the problems that this type of Bill could create.
I will again quote from the Organ Donation Taskforce document, which has a section on ethical issues.  A special working group was set up for that.  It says that:
"They were unanimous in their belief that a society has an opportunity to do something morally significant by improving donation rates, as it is an opportunity to remove suffering and bring about substantial benefits for many people.  Yet, despite this overwhelming moral good, the means of achieving this end still need to be independently scrutinised because it is also important that systems under which organs are removed for transplant are seen as morally acceptable.  In other words, the end cannot be seen to justify the means".
That is the point that I tried to make to Mr Agnew previously.  On the issue of consent, it says:
"it is then important to be able to demonstrate that each and every donation has been properly authorised; key to this is the need to be able to determine that an individual’s wishes (or those of their families, where appropriate) have been honoured. This is of importance because, even though we wish to actively promote donation, we ideally want to know that people have clearly chosen to donate ... Uncertainty about a potential donor’s wishes is at the heart of difficulties with the current system, yet uncertainty could remain an issue with an opt out system.  It may not be appropriate to assume that all those who have failed to opt out have no objection to becoming donors, given the real possibility of apathy and/or disorganisation preventing them signing the opt out register ... The group was not convinced that evidence of widespread support, as expressed in opinion surveys, could necessarily support a claim that all those who fail to opt out actively intend to donate."
I repeat again that deemed consent, as is proposed in the Bill, can never be considered as being on a level par to actual consent.  It is an issue that I have raised previously in debates on this issue, and it is an issue that I discussed at a Queen's University medical ethics debate that I participated in last year and one that was shared by many people in the room.  There were concerns that deemed consent or presumed consent could violate a patient's right to make an informed decision, and so does not uphold respect for their autonomy.
The specific purpose of informed consent is to protect a patient's right to autonomy, as is made clear in the Universal Declaration on Bioethics and Human Rights in 2005 and the Declaration of Helsinki at the World Medical Association meeting in 2008.  There are those bioethicists who argue that the concept of deemed consent is, in itself, a violation of a person's autonomy as it forces patients to either become donors or state their wish not to become donors.  In both instances, a patient's autonomy is violated, as they argue that compelling patients is, in itself, unethical.
I would much prefer to see us create a system where it is easier for people to choose to make a choice, but not making any declaration at all cannot be considered as a choice.  I hope that nobody wants to see the case where organs are being donated by default because an individual did not take the time to opt out or was not aware of the law.  Even with the fact that a family could veto any donation proceeding, the fact that the Bill would presume consent in the first place is deeply worrying for me, and I know that it is deeply worrying for many medical professionals working in Northern Ireland.  In particular, I note comments from Dr Peter Saunders, who is a former general surgeon.  He said of deemed consent systems for organ donation:
"I strongly support organ donation but so-called 'presumed consent' involves neither consent nor donation – it is neither voluntary nor informed and involves taking organs rather than giving them."
The General Medical Council also rightly focused on the importance of individuals giving their informed consent.  In this proposed Bill, that autonomy of an individual to give informed consent is removed, because consent is deemed.  At present, the Human Tissue Act 2004 is the law governing much of organ donation in the UK, and the Act makes consent the focus point of deliberation, but this Bill moves away from the focus on consent, as consent will be presumed or deemed.  I asked earlier if there was any other area of medicine in which consent would be presumed.  Even when it comes to saving someone's life, doctors will act in a patient's best interests, but they do not presume the consent to do so.  That is an important acknowledgement to make.  I have spoken to doctors, and if you appear at an accident and emergency ward and you are unconscious, if a doctor takes the decision to operate on you when you are unconscious and cannot get the consent to do so, they are not presuming that they have your consent to operate, but they are acting in your best interests.  It may seem like a minor point, but, in legal terms, there is a significant difference in the two positions.
My view is that organ donation should be authorised by the individual whose organs are donated.  The Bill allows you to withdraw consent, but it does not appear to allow you to authorise it.  In my view, we are moving away from relative certainty where an individual gives informed consent during their lives, which guides families and doctors when making difficult decisions on whether to donate, to a system of uncertainty, where families and medical professionals cannot be sure.
As I said earlier to Mrs Dobson, although donor cards can be overruled by a family, they at least prove that the individual made a positive act during their lifetime to express consent, and they give families comfort in that they know what the wishes of their loved ones were.
I am also an unapologetic supporter of limited government and hold the view that the state should not get involved in every aspect of our lives.  It could be argued that the Bill effectively — I listened to Mrs Cameron's contribution earlier — gives ownership of our organs to the state unless we specifically register to object.  Even if people dismiss that argument, what cannot be dismissed is that, through the Bill, the 108 Assembly Members will decide that someone living in Northern Ireland has given their consent to donate their organs.  I do not think that I, or any other Member, should consider it morally or ethically right that we take that decision for people.  Many patient groups across the United Kingdom have also expressed their opposition to deemed consent on those same grounds.
Katherine Murphy, director of the Patients Association, said that it is not a decision that the Government can make on behalf of people.  Further ethical difficulties arise when we consider other issues.  I talked about people who may lack capacity to make decisions, and I point to the Mental Capacity Bill and the deliberations that we have had in that forum.  Will they be supported to make a decision, and will they be asked their view?  Can they withdraw consent at a later stage?  Other questions have been asked before, such as:  how can a child give their consent?  Do they have the maturity or the capacity to give consent to organ donation?
An opt-out system is also impractical in an increasingly multicultural society because cultural and religious objections to organ donation are also important.  I do not want to labour the point, but certain religions do not believe that organ donation is in keeping with their beliefs.  How does the proposer of the Bill intend to allay concerns about cultural and religious sensitivities?  Of course, the Human Rights Act allows a person to practise their religion, so would the Bill potentially cause a difficulty with the Human Rights Act?  Would article 8 be invoked?  Again, I ask the mover whether she is satisfied that the Bill would not be open to successful legal challenge on those grounds.

Steven Agnew: I thank the Member for giving way.  He asked a question.  In the countries covered by the Human Rights Act, and where there is an opt-out system, has there been any evidence of successful legal challenge?

Alastair Ross: As the Member will acknowledge, every Bill is drafted differently.  We need to ensure that anything that we draft and pass in the Assembly is compliant.  We need to satisfy ourselves of that.  I am aware that some eminent lawyers suggested that the Welsh legislation could be open to successful legal challenge.  In the end, the Welsh Government decided to ignore that advice, but I am aware that that advice was given.  I suppose that, ultimately, until these things are challenged in the courts, we will not know.
The proposer of the Bill also talked about safeguards being built into the Bill.  I acknowledge that she has ensured that there are certain safeguards in it, but, as I said earlier, it misses the point to some degree, because, irrespective of the safeguards in it, the Bill deems that every adult in Northern Ireland has given their consent without ever asking them.  That is the area that I have major contention with.  If 90% of people in Northern Ireland, or across the United Kingdom as a whole, support organ donation, it should not be too difficult a task for us to increase organ donation numbers.  A failure to do so may, in fact, prove to be a lack of effort.  I mentioned earlier the success that the Department and the PHA have had in recent years in increasing public awareness and boosting the number of people who have voluntarily signed up to the organ donor register.  That is why I come to the view that we do not need legislation in this area at all and that there are other things that we could do to improve the situation in Northern Ireland.
As I have already acknowledged, whether I support it or not, the Bill will in all likelihood attract the support of the House at Second Stage and move on to Committee Stage.  If it does move into Committee Stage, there are a number of areas in the Bill that I think the Committee would need to look at quite closely.  I want to detail some of them.
Clause 1, "Duty to promote transplantation", places a duty on the Department to:
"(a) promote transplantation,
(b) provide information and increase awareness about transplantation, and
(c) inform the public about the circumstances where consent to transplantation
is deemed to be given, and the role of relatives and friends in affirming
that deemed consent."
Leaving aside the issue of friends, which I will return to, I would say that, generally speaking, most people will see that clause as being uncontroversial.
The Department will also be required:
"to promote a campaign informing the public at least once a year",
with regard to the proposal to introduce deemed consent.  The objective in that clause should not be controversial.  It is hard to see a downside in the Department being required to promote awareness of transplantation, particularly given that it already does some of that work, and the PHA is already doing that work in Northern Ireland.  If a presumed consent system is introduced in Northern Ireland, it will certainly need to be advertised and allow individuals to make an informed decision with regard to their organs.
However, issues do arise from the wording of clause 1.  It may seem like a minor point, but there is difficulty around the Department promoting transplantation rather than simply awareness of transplantation.  Some may argue that that is moralistic or paternalistic rather than raising awareness to allow people to make their choice.  The Committee may wish to consider that.
The Bill is not clear on what the role of relatives and friends in affirming deemed consent should be.  In a letter to MLAs today, the BMA recorded concerns around that as well.  It could be difficult for the Department to be clear with the public as to the role of their friends and relatives.  As I said, the last thing that we need in regard to the sensitive issue of organ donation at the end of life is in any way to create confusion.
Clause 1(2) states that the Department will be under:
"a duty to promote a campaign informing the public at least once a year."
Whilst that seems to be a sensible approach, the Bill is not clear on what constitutes "a campaign".  It could range from as little as sending out a departmental press release to local newspapers to as much as a broadcast advertising campaign.  If the legislation does proceed, the Committee will want more clarity around that.
We could draw a parallel with section 15 of the Human Trafficking and Exploitation Act, when the Department of Justice just sent out a press release, believing that it had thereby met its obligations to alert the public to a change in the law.  While some Members may argue that that is a less important issue, it is relevant to look at what the Department of Justice thought was adequate to be a campaign.  We should ensure that the Department of Health would have a much more sustained information campaign than simply sending out a press release.
Should the House pass the Bill, it is my belief that every citizen who is by law considered a willing organ donor by virtue of deemed consent should be made aware, at least once a year, that they are on the list, if we are to avoid confusion and potential difficulties in the event of death.  My preference is that we do not have a deemed consent system, but if it is the will of the House that we should, it is important that on an annual basis every citizen is made aware that they are on that list and told how to opt out if that is their preference.
Another point mentioned by a few Members, and it is not the primary point but it is a significant point, is the costs associated with the Bill.  The potential cost of the duty to promote is not mentioned; it is described in the explanatory and financial memorandum (EFM) as "limited".  The bigger cost is implementing the new system of donations.  The EFM provides some detail on that.  According to a research paper produced by RaISe in November 2013, which does not appear to be publicly available, the:
"indicative estimate of implementation costs of introducing the proposed legislation is between £2,081,000 and £5,149,000".
It would be helpful if that document was made publicly available to allow us to examine the figures outlined and to understand some of the assumptions within that calculation.  For instance, do the figures include the cost of IT systems, assumptions on how many organs will stay in Northern Ireland, and what variance has been taken into account should assumptions change in the values assigned to the quality of life index?  All those were factors considered by the Welsh Assembly when considering similar legislation a few years ago.
Clause 4, the most controversial aspect of the Bill, around deemed consent, requires incredibly close and careful scrutiny.  As I said, it is interesting that the BMA, which had supported Mrs Dobson in her efforts to introduce a soft opt-out system, has expressed concerns around how it has been drafted.  This is also the part of the Bill that clinicians in emergency medicine and renal units have expressed concern over.
As I have said already this afternoon, my fundamental objection to the clause is based on the ethics of changing to that type of system.  It would, in my view, see the state going beyond its rightful place.  Deemed consent is, in my view, not consent at all, and, in an area as sensitive as what happens to your body when you die, it should be the case that affirmative assent is required or at least sought.  I find it somewhat concerning that other Members do not seem to be so concerned about moving away from a system that requires actual consent to one that does not.
It is also important to note in clause 4 the potential for a backlash if citizens believe that the idea of organ donation as a gift is eroded if deemed consent is introduced.  I noticed that, on a similar clause in the Welsh Bill, Dr Peter Matthew, who is a consultant in intensive care in Swansea, said to the Health and Social Care Committee:
"My own experience is that the British psyche has a particular view that what it should do is donate organs as an altruistic gift, and if it is felt that the state is going to take over the organs, then there is the potential that people who may have been willing to become a donor will not do so.  We have seen two cases in Morriston where patients who were on the organ donation register, on hearing about this, said to their families that if the state was going to take their organs, they were no longer willing to give them.  We lost two donations because of that.  So, there is a potential backlash."
Those are not my comments but those of Dr Peter Matthew.  A number of Assembly Members in Wales noted that they had received many letters from constituents who had made a decision to take their name off the organ donor register when the legislation was going through the National Assembly.  Again, it is very much the case that members of the public are perhaps not fully aware of what "deemed consent" means.  I am concerned that, until there has been a full review of clinicians and the public, we should not have the confidence to say that they do.
The clause also assumes that a change is needed, when the percentage of the population registered as donors has consistently risen since 2008.  That is a point that I have previously made.  Of course, the work of Professor John Fabre will be of great value to the Committee in determining whether clause 4 is beneficial.
I made the point that many countries across Europe and, indeed, the world operate an opt-out system, including Estonia, Austria, Slovenia, Norway, Italy, the Czech Republic, Finland, Latvia, Sweden, Poland, Switzerland, Slovakia, Luxembourg, Greece and Cyprus, all of which have a poorer record of organ donation than we have.  I am not necessarily saying that introducing the legislation will result in a poorer rate of organ donation, but I do make the point that there is no clear evidence that an opt-out system is a driving factor in promoting organ donation.
The clause will also require quite a significant amount of investment to be made.  It is a matter of debate, and the Committee may wish to consider whether the amount of money spent on servicing the system would be better spent on the public awareness campaign and whether that could have a greater benefit to promoting organ donation in Northern Ireland.
I also have questions around what is considered "reasonable", as is stated in clause 4 where it talks about contacting those who are in a qualifying relationship.  Again, what is a reasonable thing for clinicians to do is something that we have looked at with the Mental Capacity Bill, and we need some certainty on that.  One of the other areas that I have concern around with the clause is that so much information is to be left to codes of practice.  In other Bills, we have consistently said that such important issues should be in the Bill, not left to codes of practice.  That is something that the Committee may also want to look at.
Clause 5 is about express consent.  The Bill proposes to follow the example of the Welsh legislation regarding "excepted adults" by stating that, if an individual dies:
"who had not been ordinarily resident in Northern Ireland for a period of at least 12 months immediately before dying "
their consent cannot be deemed.  The same goes for individuals who are judged to have:
"lacked capacity to understand the notion that consent to transplantation activities can be deemed to be given."
However, it is not clear how the law would treat individuals such as international students and armed forces personnel.  At present, around 8% or 9% of students at Queen's University are international students.  Most students at Queen's take degrees that last three or more years, so an example would be, if we had a Malaysian student at Queen's taking civil engineering, he or she will be in Northern Ireland for a period of three years for the degree but is unlikely to be there continuously for those three years.  During the summer break, the student may decide to return to Malaysia before returning to Queen's for the autumn term.
If they return to Northern Ireland and, sadly, pass away, are they to be considered ordinarily resident in Northern Ireland and therefore deemed to have consented, as provided for in this Bill?  Similarly, a member of the armed forces may be in a foreign military base for most of the year but resident in Northern Ireland.  I seek clarity on how they are to be dealt with under this legislation.
Clause 6 deals with express consent of children.  I have some concerns around that and clause 7.  Clause 6 allows children to expressly consent to donation of material covered under clause 2 while alive or after death as a child through their own consent, if considered capable of making such a decision as provided for in clause 18(3), or by appointing a representative.  Clause 7 allows a child to expressly consent to transplants involving excluded material, to be defined in future regulations.  Of course, leaving such matters to regulations is of concern from the scrutiny point of view.  Organ donation by children is a controversial subject that needs much further discussion.  In particular, how will a child be judged competent to give consent and understand exactly what it is they are consenting to?  As I have mentioned on numerous occasions, members of the Ad Hoc Joint Committee on the Mental Capacity Bill will be well aware of the issues connected with the ability of children to give consent to medical operations.  The lack of consistency in the approach by some members of that Committee today has not gone unnoticed.
Clause 8 deals with deemed consent in activities involving material from living adults who lack capacity to consent.  It proposes how to deal with the consent of a person who has died but did not have the capacity to consent to the donation before death and requires a third party to provide consent for the person.  Clause 8 allows the law to deem consent for such individuals while they are alive in circumstances of a kind specified by regulations made by the Department.  The explanatory and financial memorandum says:
"there may be circumstances where it may be in the best interests of a person incapable of giving consent, to donate material to a living relative."
However, there is no indication of the type of circumstances that may be considered applicable, as there is in clause 7(3), nor is there any explanation of why this might be in the individual's best interests.  Most importantly, there is no safeguard on who can agree to such a donation.  I am concerned that vulnerable adults who cannot consent should have the full safeguards of the law, and it is not clear that they do under this clause.  I am not reassured by regulations made under a similar clause in the Welsh legislation, stating that the adult who lacks capacity:
"is deemed to have consented to the activity where the activity is done by a person who is acting in what they reasonably believe to be P’s best interests."
There is no further clarity on the person who can make this decision.  Again, I draw a parallel with the Ad Hoc Committee and the questions that we raised on best interests.  I fail to see how it can be judged to be in an individual's best interests to donate their organs without consenting.  It would, of course, be in the recipient's best interests, but I think that Mrs Dobson may wish to explain to the House how it could be considered in the donor's best interests when consent has not been established.  It is something that I was a little bit confused about when reading through the Bill.
Clause 10 talks about the qualifying relationships.  It sets out the type of people who can provide express consent to organ donation.  This clause is based on section 27 of the Human Tissue Act 2004, which sets out detailed instructions on how this should be interpreted.  For instance, are those at the top of the list ranked higher than those at the bottom?

Gordon Lyons: I thank the Member for giving way and for the breadth and depth of his evidence.  He has certainly brought more than anybody else, and it has been very helpful indeed.  I also have concerns about qualifying relationships in clause 10.  Does the Member share my concern that the Bill very clearly defines what a partner is, "for the purposes of this Act", but does not define a "friend of long standing"?  Instead, this will be left to the code of practice.

Alastair Ross: Yes, I have made the point about the difficulties created from a scrutiny point of view of leaving things to the code of practice.  Indeed, Committees that I have sat on are continually having disputes with Departments about leaving things to codes of practice, bearing in mind that you cannot amend them; you can simply accept or reject them.  I have not come across the notion of a friend of long standing in any other legislation.  How would we ever determine what a friend of long standing is?
There are also questions about how a nurse or doctor in a trauma unit would determine how to establish who a "friend of long standing" is in order to contact them to ask them whether to proceed with an organ donation.  That is an area that the Committee would undoubtedly want to investigate more thoroughly.  I think that it is an odd phrase to see in a Bill.  Even though the Member says that she will leave it to regulations, there would be huge difficulties in determining what a "friend of long standing" is.
I think it would be important to see whether, in that list of qualifying relationships, the ranking order could be made under the code of practice, as proposed in clause 10(4), rather than in statute.  I question whether any legal weight is given to the order of ranking.  Again, I draw a parallel with the Mental Capacity Bill, where we received advice that the order of ranking makes no legal difference at all.  That would be particularly concerning, especially given the point that my colleague, Mr Lyons, has just raised, that, if there was no legal difference in the ranking, then, potentially, a "friend of long standing" would be the first person who could be contacted.  Given the difficulties that there would be in establishing exactly what that relationship is, how close that relationship is or what kind of knowledge that person had of the individual, I think it would cause some concern.
Clause 14 refers to an annual report on transplantation.  Again, the Bill sensibly requires an annual report on transplantation to be introduced.  It requires the Department to include in the report, of which there will be at least one every five financial years, its opinion on whether the Act had been effective in promoting transplantation activities and any recommendations for amending the law so as to promote transplantation activities.  I suggest that consideration should be given to making the interval under clause 14(3) three years rather than five.  Then, should the Bill be passed and make little or no impact, it could be repealed within a fairly short period of time.
Clause 21 refers to commencement.  It is important to note that the date of the commencement of the new system is proposed as 31 May 2018.  This suggests that there would be a two-year period of preparation before implementing the Bill.  Given the very real concerns about it, and its impact on the ethical questions I have raised today, I would prefer to see work commissioned by the Department that would consult with clinicians directly impacted by the law in order to establish whether they would be comfortable working in this new legal framework before the Bill is enacted.
Members have referred to the consultation process that was carried out, but any consultation that has been carried out has been in absence of the Bill.  It has been very difficult to get a draft copy of the Bill over the past number of years.  We have talked about broad concepts but we have not seen the detail of it, so I think that consulting in the absence of the wording shows a shortcoming in the consultation process.  I think that it is important that doctors can see the detail and that we should specifically ask them about how they feel about the proposed changes it the legal framework in which they would then be required to operate.
It is easy for people to dismiss concerns expressed about the Bill as being politically motivated, or simply say that the Bill is about saving lives and that anybody who opposes it is not interested in doing that.  It is my firm view that the Bill will fundamentally shift the relationship between the state and the individual.  It is my firm view that the Bill, and what it is trying to do, is unproven internationally, is potentially counterproductive and unnecessary, and, worst of all, moves us away from the well-established need for actual, informed and expressed consent before carrying out a medical procedure on an individual.  The lack of consent that the Bill would legislate for makes me deeply uncomfortable and requires me to vote against its passage at Second Stage, because the principle of the Bill is about moving towards deemed consent.
I appeal to Members to detach themselves from the powerful emotional arguments we have heard previously in this debate and consider the fact that, by passing the Bill, a person would no longer need to give their consent for them to be considered in law as a willing organ donor.
I will finish by once again quoting Mrs Dobson speaking in a previous debate on promoting women in politics.  She said:
"we need to inspire change and not to force it.". — [Official Report, Bound Volume 93, p12, col 2].
Anyone who reads or listens to the extraordinary stories of people who have donated their organs, or who have had loved ones donate their organs on death, and saved up to six other lives, or anyone who have benefited from such an amazing gift of life, could not fail to be inspired.  
Let us not move away from the concept of organ donation as a gift.  Let us inspire others to give the gift of life by making a decision on whether they wish to donate their organs and help others.  Instead of looking to pass legislation on the issue, let us work together to promote the real drivers of organ donation, namely increasing public awareness of organ donation and ensuring that we have the specialist transplant coordinators in every hospital across Northern Ireland.
I appeal to Members, particularly those on the Health Committee, to look at the evidence, get beyond the notion of whether countries operate an opt-in or opt-out system and look at the real drivers for promoting organ donation across Europe and the world.  If members of the Health Committee do that, it is my belief that they will quickly come to the conclusion that the most important factors in promoting organ donation are public awareness and having transplant specialist nurses in hospitals who are specially trained to recognise potential organ donors and deal with families in particularly difficult circumstances.  If they come to that conclusion, they will also come to the conclusion that we do not need legislation on this issue; we just need a Health Department focused on delivering those changes.  I think it is absolutely in our gift to do that.
I hope that, despite perhaps discussing the issue at length, I have injected some form of debate and some level of scrutiny into this Bill at Second Stage.  I hope that Members will take those concerns genuinely and have a rational and balanced debate about whether the Bill is the most appropriate way in which we in Northern Ireland can boost organ donation rates.

David McIlveen: I welcome the opportunity to speak on the Bill at this stage.  I will try to speak briefly.  Like others, I want to congratulate the sponsor.  A tremendous amount of effort goes into drafting, formulating and consulting on a Bill.  There is also a lot of pressure and stress when you find yourself on the other side of the Committee table.  Therefore, I want to commend Mrs Dobson on her work.  I note that it is obviously inspired by personal circumstances as well.  I know that she has been a very effective lobbyist on the issue, and I commend her on that as well.
I want to start by saying that I am on the donor list.  I have been for over 10 years, I think.  Admittedly, my organs may not be as healthy as those of some of my colleagues.  I think particularly of my good friend, Mr Wells, who has left, with the meat-free, alcohol-free, every-pleasure-free lifestyle that he leads.  Unfortunately, I do not think I could fall into that category, but I did make that personal choice some time ago.  Therefore, whilst I do have sincerely held, genuine concerns about the potential road that that particular approach to the legislation could take, in a desire to see a significant increase in donors way beyond where we are at the moment, I stand entirely shoulder to shoulder with Mrs Dobson and with everybody in the Chamber in wanting to achieve that outcome.  My concern, however, is just around how we actually get to that point.
Of course, on the surface, I guess the Bill looks like a no-brainer.  We should all be dancing out the Yes Lobby to try to support it if it is to achieve what we believe it is designed to achieve.  However, when we start to look at it in more detail and unpick the potential consequences of going down this particular road, whether we call it presumed or deemed consent, I think we have to be much more cautious about how we actually get to that point.  I know that it has been mentioned already, but I am yet to be convinced, or have anybody on the other side of the argument convince me, that there is any precedent set in any part of the public service where a split-second decision like this — something that is so important to people and that obviously raises big ethical issues — can be done on the basis of silence meaning that it is assumed.
It is a principle that continues even when you look at issues beyond health.  If someone pleads guilty in a court of law to a crime, there is not an assumption that they are guilty; they will be given a trial and the evidence will be interrogated.  It is quite likely that, if someone pleads guilty to a crime, they are most likely guilty of that crime.  However, my point is a general one, in that, on that basis, there is not an assumption of guilt.
If someone does not have a will, it is not assumed that whatever is left behind will go to one particular person or another.  A very long process is undertaken and gone through with publicity, publication and probate to ensure that, as best as possible, the desires of the person who has passed away are taken into account.  As politicians, we do not assume that the decisions that were made at the last election are the decisions that people will always want to make.  We have elections every three, four or five years.  There is an assumption that people's minds will change, that people will have different views, and that the views of today may not necessarily be the views of tomorrow.
I opened by saying that I am on the donor register.  However, for many years of my adult life I chose not to be.  At some time in my future life, I cannot rule out deciding that I want to be taken off it again.  That is how life is:  sometimes we change our views.  In politics, we are often castigated when we change our minds — it is called a U-turn — but that is life.  People change; people change their views and have different ideas as they grow in experience.  That is extremely healthy.
An issue raised by the sponsor of the Bill equally needs to be looked at.  In the health service, if someone is sectioned under the Mental Health Act, it is not a simple matter of that person being sectioned in a split second.  A process has to be gone through, and the person who has been sectioned is given an opportunity to challenge.  Therefore, it is not assumed that that person is in need of being sectioned under that piece of legislation.
I can think of an instance — it could be over 10 years ago — of a little baby who was abandoned and subsequently and tragically lost her life as a result.  There was considerable controversy because an assumption was made by the state about what type of burial that child would have — there will always be people on the other side of the argument who will say that it was the wrong one.  To over-trivialise the issue and to assume that this is a very simple approach, and that you can up organ donations as a result of presumed or deemed consent takes away from the very deeply held and sincere opinions of many who believe that it should be looked at in a different way.
I do not accept that the opt-in approach has been fully exploited.  I do not accept that every effort has been made by Government to ensure that people are given that very important choice — a choice that I urge anyone to make — that they are on that list so that people can benefit from those organs whenever they leave this scene of time.
We now live in a world where forms and bureaucracy are just the order of the day.  We are well used to it.  Whether it is to do with filling in our passports, driving licence, pension credit forms, HMRC forms or social security, there is a plethora of publicly published forms that every person, no matter what their age or walk of life, will find themselves engaged in and having to sign.  I do not see any reason why we could not look at an approach such as that first, before we veer into territory that has an extremely difficult ethical question for us to answer.  I would much rather not be in that position.
I am not motivated really by faith when it comes to this particular issue.  I take the view that when it comes to what happens to our bodies after we are gone, it is probably well worked out by a much higher hand than mine.  Therefore, it is not a motivation of faith that brings me to this position.  However, it is a motivation of caring about what the state has control of, and of caring about the state assuming that, because I do not do something or my constituents do not do something, I and they are consenting to something else.  I find that deeply troubling.  It is something that we should all be aware of and something that, I think, we should all interrogate as thoroughly as we possibly can.
The fact is that the issue of affirmation already exists.  Therefore, I do not see affirmation being the safeguard that is required to make this a good piece of legislation.  In fact, quite honestly, I would have no difficulty about having a proper debate around the issue of affirmation in itself.  I have considerable difficulty and would be extremely vexed — I have had this conversation with my next of kin — if my next of kin were to come along in the event of my death and say, "Well actually, his wishes are not my wishes, and therefore I am going to stand in the way of his organs being donated".  I have considerable difficulty with that.  I believe that, so long as my decisions are made sincerely and with a sound mind, they should be honoured.  Therefore, the issue of affirmation is something that, should a better piece of legislation be brought to the Assembly, we could perhaps look at in a lot more detail.
I want to touch again on the issue of the split-second nature of this.  I think that this is where there is a difference and we do need legislation.  We have often heard it said on issues as serious as this that you do not need to legislate; that you should maybe look at guidelines or something that will make things a little bit easier.  To be honest, I do not see anything other than legislation dealing with this issue once and for all.  That is because, ultimately, we are dealing with a split-second decision.  This is unlike a court process or the issues that I listed before, where time is given.  This is a split-second decision where a family member, as we stand at the minute, can decide to consent or not consent to the donation of organs.  Therefore, I think that legislation is probably the best way to deal with that.
In summary, to opt out presumes that we know the time of our death.  The fact is that we do not.  I do not know what will happen to me as I drive back to North Antrim tonight.  None of us knows what will happen as we drive back to our constituencies.  Under this legislation, should it go forward, had I not got round to making my true feelings known about whether to opt out or opt in, an assumption is made that, regardless of what happens to me tonight, I consent to my organs being donated.  Yes, my family has a veto, and I understand that.  However, this is not about my family; it is about my wishes as an individual.  This is about my choice, as an individual.  Therefore, I have considerable difficulty that, in the event of my life being cut short, this state — this Assembly — has made an assumption of what my desires are.  I find that deeply troubling, and I have considerable difficulty dealing with it.
I desperately want to support a Bill that will help deal with the issue, that will help increase awareness and that will help to get more people on the organ donor register.  I genuinely do not believe that this Bill is the way to do it.  Therefore, I am asking the sponsor and the Minister to look at a more progressive way of dealing with this.  This is punitive; this is going to the very last resort first.  If we go through a process where opt-in is made similar to the Spanish model that we have heard a lot about today, and if that is given a try and we find that in one year, two years or however long it has to be gauged, that we are in a position where it has made little or no difference, then, yes, let us bring it back and start having a discussion about what else we can do.  However, as far as I am concerned, presumed consent is the last chance saloon.  It is the place that you get to if all other options have failed and, even then, it is still going to cause an ethical issue.  However, we are not at that point, and we have not exploited the other options that are open to us first of all.  Therefore, I appeal to the sponsor and the Minister to get back round the table and see whether a more simple, a more effective and a more ethically neutral position can be found to bring the outcome that we all want to see.

Edwin Poots: I, too, will be brief.  It is an important subject, and I welcome the fact that we are having this debate.  The motivation behind the Bill is good and the principle behind it is soundly based.  Is it the right legislation?  I very much doubt it.  I think that, even if you were to accept the principles of the Bill, it would require substantial amendment, and I accept that, in fairness, that is what the Committee would and should be doing.  Do I think that the actual principle of the Bill is right?  At this stage, I am not convinced.  We need to proceed very carefully and with extreme caution on this hugely sensitive issue.
In Northern Ireland, we have an excellent record on organ donation, both live donation and deceased donor donation.  Many people in other parts of the United Kingdom are quite envious of the willingness of people in Northern Ireland to donate their organs.  We are privileged to have one of the best kidney transplantation teams in the world.  It was reported recently that a record number of transplants was carried out here in little Northern Ireland in one day; I think that it was six, equalling somewhere in the United States — five — and that is a demonstration of the fantastic people that we have, the skills that exist and the ability of Northern Ireland to do this really well.  That goes back to the days of Professor McGeown and Dr Douglas, who started off organ donation.  Indeed, my uncle received his transplant from him very many years ago.
We can be very proud of what has been achieved and what is being achieved.  Therefore, if we are going to radically change that, we need to be very cautious that we are doing the right thing, not just that we are doing it for the right reasons, because that is not in contest here.
One of the reasons why I wanted to speak in this debate, albeit briefly, is that I was particularly struck by something when I was Health Minister.  We held a full-day session on organ donation at the MAC a couple of years ago, and we had all the key players there.  The closer you get to the intensive care units and the medical people who are dealing with individuals and families who have a tragedy on their hands and have to deal with death, the less inclined they are to go down this route.  They are very clear about that.
In the Belfast Trust, we have six specialist nurses for organ donation (SNODs) who are available at all times to be called upon when it is evident that someone is going to die.  Those nurses have immense expertise in very carefully going through a process with people who are in the midst of the most awful grief, steering them through that process and encouraging many of them to willingly have organs donated.  Those nurses cherish their ability to deal with people in a pastoral way, a caring way and a way that puts the family at the centre of the decision-making process for their loved one.  Those specialist nurses indicated to me that they did not want this tool, which was seen as the big state stepping in and saying, "These organs really belong to us anyway, so we are just going to move in here."  That is not how they want to do it, and it is not how they believe they will get the best results.
I accept that the motivation behind the Bill is good.  We all want to see people's lives saved.  I always find it remarkable that there is a much greater willingness among people to receive organs than there is to donate them.  I do not understand why people cannot step up to the plate and say, "If I am happy enough to receive someone else's organ if I needed it, I should be happy enough to donate my own."  However, it is absolutely critical that all we do is done in a very measured and very thoughtful way and that we do it at the appropriate time.
My fear is that this legislation will go to the Committee and that, in the very short space of time that is left of this Assembly, we will have the potential for rushed legislation.  Rushed legislation is seldom good legislation.  When it is dealing with something of this nature and capacity and will have a massive impact on people who are going through the trauma of losing a loved one, very often in circumstances that they could not have anticipated, we need to be hugely cautious about what we do.  It is easy to do something in this Chamber.  Walking through one of those Lobbies is not difficult, but when you are sitting in an intensive care unit or another specialist area of a hospital and you are one of those nurses dealing with a family that is in the midst of a grieving process, it is different.  You would do well to pay a lot of attention to what they have to say.
I urge the Assembly to be extremely cautious about what it decides to do, either today or at a later point.  We need to take our time and get this right.  We will have a new mandate come May, and it is important that we ensure that we do the right thing for the Northern Ireland public.  We all want to see more lives saved.  Just let us make sure that we get it right.

Steven Agnew: I congratulate the sponsor, Mrs Jo-Anne Dobson, on getting the Bill to this stage.  Having just finished the process of a private Member's Bill, I know about the challenges and the frustration with drafting.  I have not spoken to Mrs Dobson about that specific aspect and the challenges she may have faced, but I certainly found that to be the most frustrating part.  Having the idea is fairly simple, as is, to some extent, defending it to the House, but getting the idea from concept to fruition and bringing forth a piece of legislation is challenging.  Indeed, going through the stages of the House and getting the legislation right is challenging.  I welcome the fact that Mrs Dobson acknowledged that, where the Bill can be improved, she will work with others.  I had to do that with my Bill.  Some almost used it as a criticism against me.  They said, "Well, this Bill's significantly different at Final Stage than at Second Stage".  I think that it is a strength, rather than a weakness, of a piece of legislation that it is worked and reworked until it is right.  Of course, a group of people working together is going to produce a better piece of work than an individual working alone.  In most instances, that is going to be the case.
Mrs Dobson reminded the House that it is Green Party policy to support the soft opt-out option.  That is what I rise to do this evening.  Organ donation is one of the wonders of modern science.  Innovation in health — what can be achieved and what human beings have managed in terms of treatment and keeping people alive — never ceases to amaze me.
The term "gift" has been used.  Organ donation is indeed a gift.  It is one that I have chosen to opt into in our current system.  I would certainly be happy to have the provisions of the Bill applied to me.  I am also proud to be a platelet donor.  My partner, in the birth of both our children, required platelet transfusions.  I thank those who chose to donate platelets for their generosity; they helped to ensure that her life and the lives of my children were protected.  With blood donation, platelet donation and organ donation, there is the ever challenging issue of keeping the awareness there and keeping the issue in the public mind to ensure that donors take time out of their busy lives, in the case of living donation, and are sufficiently aware, in the case of deceased donation, to, in advance of death, make that aspect known.
We have seen from the sponsor's consultation, the Public Health Agency polling and the UK-wide polling, the level of support out there for organ donation.  Whilst I accept that there is not a direct correlation between supporting organ donation and being a willing donor, I think that there would be a strong correlation between them.  That is some of the basis on which I support the legislation.
I first raised the issue of a soft opt-out system — and I was checking the date — exactly four years ago today in a question for written answer to, as it was then, Minister Poots, asking what consideration had been given to such a proposal.  It was in the context that the Welsh Assembly was considering the issue.  I was hopeful at that time that legislation would come forward from the Department.  That, obviously, has not been the case.  I welcome the commitment of the Member to bringing it forward in the absence of progress from the Department on the way forward.
My personal connection to it is through my relationship with one of my constituents, William Johnson, who will be known to Mrs Dobson.  He has campaigned tirelessly to promote organ donation.  He spent the best part of a decade on dialysis, but has, thankfully, received a successful transplant and is experiencing the benefits of that.  For many years, he was — I was going to say the word "frustrated", but in fact I never knew him to complain — but he was one of those people who, in the absence of an available organ, had to suffer the lesser quality of life of having to live on dialysis, without receiving a transplant, until recently.  When it comes to the Bill, the key question has to be:  will it work; is it effective?  There have been differing interpretations of the evidence.
I come now to some of the points that Mr Ross raised.  If we are convinced that we have the evidence that it works, then, in my view, the end does justify the means.  I have listened to the Member's concerns, but I am not compelled that his fears about the role of the state in any way negate my desire to see more lives saved through an opt-out system, if the evidence is available that the opt-out system will increase donation.  Mr Ross has questioned that evidence.
I looked to the evidence of Shepherd et al, from 2014, which concludes that countries that have an opt-out system across the board have a higher donation rate than those that have an opt-in system.  The evidence also suggests that the opt-out system alone is not enough to ensure greater donation.  Whilst the correlation suggests that the opt-out system will lead to increased donations, on its own it is not sufficient to maximise donation.  I await the Health Minister's response, but I urge him to support not just the legislation, but the other areas of best practice that are required to maximise the benefits of the legislation, because I think the legislation is part of —

Alastair Ross: Will the Member give way?

Steven Agnew: Certainly.

Alastair Ross: If the Member is encouraging the Minister to look at the areas of best practice, that will be Spain and the United States of America.  Does he accept that neither of those countries use presumed consent?  So he is actually asking the Minister to move to a system where we will not have presumed consent and where we maintain the voluntary opt-in system, but where we have greater public awareness of the issue and specialised nurses in hospitals.  Those are the two drivers that have evidence from around the world, rather than moving towards presumed consent.

Steven Agnew: I thank the Member for his intervention.  I referred previously to the evidence that, when taken in the round, the correlation is that countries that have the opt-in system perform better than countries that have the opt-out system.  Whilst there may be countries that are doing other things that have improved organ donation — the Member mentioned some of the areas, such as the speciality transplant nurses — that does not preclude an opt-out system.  The two can go hand in hand.
Looking at the evidence, I very much believe that the — I better make sure I get my terms the right way round — opt-out system is beneficial, but, on its own, it is not the silver bullet; it on its own will not achieve everything.  We should look at the examples of best practice and at countries where things are being done well, regardless of whether there is opt in or an opt out, and replicate the other areas as well as the soft opt-out system.  My interpretation of the evidence is that it increases the likelihood of positive outcomes in organ donation.  I think that that has to be the approach.  I do not think for a second that we can pass this legislation and say, "Problem solved.  We have a queue of donors; we will no longer have a deficiency of supply."
We need to look at the other areas.  One of the most important things is to ensure that quick decisions are made and that organs are properly preserved, transported and maintained.  This is one part of the picture, but it is a positive and significant part of how we improve in this area.
Looking at the best evidence — and promotion was raised — we still need to ensure that families know the will of the individual.  That does not go away.  We need to ensure that the pastoral care that Mr Poots mentioned is still there.  Families will be no less grieving whether we have an opt-in or an opt-out system.  The Bill does indeed empower the family; it keeps a degree of power and say with them.  I know that there will be some debate about what that should look like.  One of the key parts of the Committee scrutiny and amending stages will be to ensure that we have that aspect of the Bill to balance deemed consent with the views of the family.  We have to ensure that we get that right.
It is not simply a matter of, "Pass this legislation and problem solved":  we still have to be diligent, promote the legislation and raise awareness.  We still need that conversation.  Indeed, as Mr Ross highlighted, Mrs Dobson's bringing the Bill forward has increased awareness in and of itself.  I go back to my own Bill:  I know the frustration with the time that it takes to get to this stage.  The advantage is that awareness of your Bill is now greater because of the time that it has taken; the time that there has been for discussion, media interest and debate in the Committee and in the House.  That is all positive.  Indeed, should the Bill be passed, as I hope it will, the two-year lead-in time will allow for that debate to take place and public awareness to be raised.  Those are all necessary pieces of the jigsaw.
Figures have been discussed, so I will not go through them, but it is clear that there is support for organ donation.  It is clear that the vast majority of people support it.  Unfortunately, the vast majority are not on the register.  That is a discrepancy and a problem that the Bill will go some way to tackling.  Mrs Dobson's consultation has had a positive response.  Previous polling indicates that there is positive feeling towards this type of legislation.  The Committee consultation will further tease out the evidence, so, by the time the Bill makes its way through the House, it will get significant public attention and will be an opportunity for the public to articulate its views.
As I say, the legislation will not fix the situation overnight, but it will create an opportunity to build on the good work that we have already done on organ donation, enhance it and make Northern Ireland a leader in organ donation rates.  That is the opportunity.  It requires the legislation, the goodwill and dedication of the Minister and his Department, and that public awareness campaign.  Collectively, those things provide us with a tremendous opportunity that, I hope, we will not let go to waste.

John McCallister: I am long on record as advocating this type of approach.  I would like to begin by congratulating Mrs Dobson.  I know the huge volume of work that goes into bringing a private Members' Bill in normal circumstances, and one with as many challenging issues as this Bill is particularly difficult.
Of course, as with every piece of legislation, Members have quite rightly used the usual tactics of trying to kill it by saying that it might not be compliant with human rights or that the Welsh were advised against it but ignored it. All those arguments will be made against the Bill, as we have already heard today.
In raising the issues, the Bill and the debate — not only the debates that Mrs Dobson has had over the past few years as this policy has been developed but the publicity and the public debate — have been to the good. Strangely, one of the key issues — other Members have alluded to it — is that, when you have consented to donate your organs, your family can overrule that consent.  It is about having the debate here, but it is most important to have that discussion at home with your family to make sure that there is absolutely no doubt about what your wishes would be.
Of course, like many colleagues here, I have met constituents and know constituents very well who have received donations or are organ donors.  I know families who have been in those very difficult circumstances, and I know that it brought them some modicum of comfort that their loved one was fit to bring life, give life and extend life to others in what can only be the most horrendous circumstances that anyone would ever face.
The publicity and the debate and having that discussion around dinner tables at any time about what people's wishes would be are hugely important.  That is why public debate is important.  Were the Bill not to be amended in any way, it would probably be the only Bill that ever went through the House or the Committee process and was not amended.  That is why I am very opposed to accelerated passage when Ministers propose it, because there is an expertise at times that the Committee can tap into and use to tease out the issues and, at times, address concerns. It will not address all the concerns that Mr Ross has expressed, because he is opposed to the principles of the Bill.  I know, from knowing him, that his are deeply and sincerely held views.  In some regards, I am probably closer to his views on the size and role of the state, but I disagree with him on this. I think that we can address some of his issues and make it easy for people to opt out.
The discussion and the publicity campaign on those issues should not just be a one-off if the Bill is successful but should be ongoing.  As Mr Agnew pointed out, it is about looking at best practice around the world and not being afraid to challenge ourselves about what our Department, our hospitals and our units do.  Can we improve, and can we put coordinators in place who can deal with that and help to increase numbers?  Quite frankly, we lose too many organs where there is some discussion and the wishes of the family are unclear.  We lose too many viable organs that could prove to be a life-saving donation to others.  That is of huge regret to us all.
I do not doubt that everyone here is sincere about upping our game significantly in what we do with organ donation, and I thank Mrs Dobson for having the tenacity to introduce the Bill and to keep going with it.  The Committee will work hard at it.  It will get its Committee Stage, and the Committee will possibly have to work hard to keep within the six-week period.  If it needs an extension, it will have to get an agreed timetable that will allow the Bill to get the detailed scrutiny required and to make sure that the process, including any amendments, changes or advice that the Department may bring, can be completed by the end of the mandate.  The issue is too important for us not to make some significant progress on it.  I support the Bill.

Claire Sugden: I support the Bill's Second Stage because the overarching principle, which we should all consider, is that it will save lives.  That said, I am not fully convinced by some aspects of the Bill, and it is usually the aspects that are dependent on each other, because it almost seems that one thing has to happen for the other to be fulfilled.  Therefore, I believe that it is necessary that we challenge the Bill and look at the aspects of it that we are unsure of in order to uphold its integrity moving forward.  It is an important Bill, and it will affect people's lives. We have a responsibility as Assembly Members to give it the consideration that it deserves.  In the legislative stages to come, we look forward to doing that.
I acknowledge Mrs Dobson's commitment: it began on the birth of her son, and she has carried it through to the Chamber.  She has also instigated debate outside the House.  I understand that, since the public debate in January, there have been more cases of organ donation.  Even if the Bill should fall at whatever stage in the Assembly, Mrs Dobson should be proud of the fact that she has saved and changed lives.
While preparing for the debate last night, I raised the issue with my partner and we had a conversation.  I made my wishes clear: I said that, should anything happen to me, I would be more than happy to donate my organs. I believe that I am on the register; I am not quite sure.  I ticked that box when I was upgrading my driving licence.  I think that I have gone online, but there has been no follow-up since, so I am not sure whether I am on the register. Perhaps that is my fault, but it is assumed in my own head.  Even that in itself is a problem.  Should something awful happen, God forbid, and my partner is not approached and I had wanted to give my organs away, someone would have lost the opportunity to have his or her life saved or improved greatly.  Mrs Dobson's proposal removes the confusion and gives another opportunity to save a life, and I keep coming back to the point that that is the overarching principle of the Bill.  While I have reservations on some aspects, that is something that we should all bear in mind.
I wish to consider the public consultation on the Bill.  It demonstrates that, of those who responded, 82% agreed to change the law to soft opt-out.  I very deliberately said "those who responded", because I know that a Public Health Agency survey indicated quite a significant figure.  I do not believe that the comparison of the two undermines the public consultation conducted by Mrs Dobson; I think that it represents the view of those who are informed about organ donation that it is the right way to go. It strengthens the case that we need to have some sort of public awareness campaign around organ donation, because the likelihood is that most people would then subscribe to it.
I will touch on some of the aspects that I am maybe questioning.  I would not go as far to say that I disagree with them, but I am certainly not convinced.  Indeed, for me to move forward in supporting the Bill, I have to feel that I am convinced on these issues.  Like other Members, I have looked at family consent.  On one hand, I believe that the Bill will strengthen the purpose of family consent.  Does someone wish to confirm for me that family consent is required by European law?  I think that the Bill will reinforce that and make it stronger.
I recently read the Hansard report of Mrs Dobson's presentation to the Committee, and I would like her to clarify a point for me.  Is it currently the case that clinicians are able to remove organs from deceased registered donors without the consent of family should they not be available to take the decision, for example?

Jo-Anne Dobson: Will the Member give way?

Claire Sugden: Yes, sure.

Jo-Anne Dobson: I thank the Member for raising that point.  Quite a lengthy document needs to be signed, and no clinician would ever remove organs without having that consent.

Claire Sugden: I appreciate the Member clarifying that for me.  If it is the case that people on the organ register cannot donate their organs without that consent for whatever reason, are we losing people who are willing to donate because a family member maybe has not been available to sign that consent form?  I appreciate you clarifying that for me, because it does not weaken the argument in any way. I also noted during your presentation —

Alastair Ross: Will the Member give way?

Claire Sugden: Yes, please go ahead.

Alastair Ross: I thank the Member for giving way.  For anybody who wants to see a higher rate of organ donation, one of the major issues is how you get a higher rate of family consent in a difficult position.  My argument is that, with an opt-in system, at least family members have something to make a judgement on, because they have either had that discussion with their loved one, or their loved one has signed up to the organ donor register.  Whilst signing up to the organ donor register on its own will not necessarily lead to an organ donation, at least the family have something solid to look at in guiding them to their decision.
My concern about moving to presumed consent, deemed consent and an opt-out system is that an individual does not have to make a declaration that they are a willing organ donor during their life; they simply do not have to do anything.  Does that give the family more or less certainty when they are being asked the question?  My contention and some of the evidence from elsewhere in the world is that clinicians feel that that gives families less certainty because a loved one has never made an active move in their life to say that they are a willing organ donor.  In those circumstances, the Bill will be counterproductive, and that is where one of the concerns comes from.  Does the Member not accept that what we want is people to give an indication during their life that they are a willing organ donor, rather than trying to move to a position where silence on the issue is somehow interpreted as consent, which will put families in much more difficult circumstances?

Claire Sugden: I thank the Member for his intervention.  I do not quite accept that rationale, because I think that people who really do not want to give their organs should they pass away will make that clear to their family.  It is a case of changing the culture and the ethos in Northern Ireland.  I was quite taken by a quotation from someone who, when presenting to the Committee alongside Mrs Dobson, suggested that we should nearly make this part of the dying process, and that seems to be the case in other parts of the world.

Alastair Ross: Will the Member give way?

Claire Sugden: Yes, please go ahead.

Alastair Ross: I just want to ask where the Member gets her confidence that, by not opting out, that person has made an active decision and that they would have told their family members.  There are many reasons why somebody will not have got round to opting out of organ donation.  How does that give families certainty that they know what their loved one's wishes were?  That is the major concern.  If somebody has never been forced to make the decision in their life, it makes the family's decision much more difficult, which leads to a higher refusal rate when it comes to family consent.  I just do not see where she gets her confidence that anybody who is opposed to this will necessarily opt out if they do not know how do it or are not aware that they are on the list and all those sorts of issues.

Claire Sugden: Again, I thank the Member for his intervention.  I do not suppose that we can ever be confident in that.  I suppose that it is one aspect of the Bill that it has to coincide with a really significant public awareness campaign.  Equally, I could say this: where do we get the confidence that my wishes to donate my organs and potentially save four to five lives will be respected after I am gone?  I do not have that confidence.  The overriding principle for me is that we will save lives in this respect.  I do not think that we can have certainty on both sides of the argument, but, at least on one side, we are increasing the opportunity to save lives.
I want to bring in my other concern about family consent.  I know that, in Committee, a couple of Members raised the issue of whether consent meant consent.  That goes back to my point about having confidence that someone will fulfil my wishes should I pass away.  I fully appreciate that the family needs to remain central to this, but there will be cases where, although the deceased was willing to donate an organ, their family will not be willing to make that decision after their death.  That is entirely understandable, and I appreciate the reasons around that.  Has Mrs Dobson considered provision for willing donors who know that their families would not be able to make the decision in the event of their death?  In a soft opt-out system, could there be provision for people who really want to opt in and want to donate their organs after death that almost overrides the family decision?  For example, could it be done even through their last will and testament, if that were possible, although I know that timing can be a bit difficult in that respect.  According to this legislation, would it supersede the family consent element, or would it even supersede the European law around the family needing to consent to it?

Jo-Anne Dobson: I thank the Member for giving way.  I also thank her for her interest in organ donation.  You alluded to the fact that you can make your wishes known in a will.  Given the timing and the critical window we have for transplanting organs, that would not always be the best way.  The safeguard you are talking about is ultimately to make sure that, if you are a passionate supporter of organ donation and you want your wishes to be considered and are not sure if your family can make that decision, whether it is through grief or if they are opposed to it, this would be where the advocates would come in to make your wishes known.

Claire Sugden: I thank the Member for her response.  The next question that came to my mind is that the current system is not stimulating the conversation around organ donation.

Alastair Ross: Will the Member give way?

Claire Sugden: Sure.  Go ahead.

Alastair Ross: I thank the Member for being so generous in giving time.  She made an interesting point about somebody who makes a declaration during their life that they want to be a willing organ donor but knows that their family may veto that.  It is an interesting area, and it is one that some of my colleagues have raised with Mrs Dobson in Committee.  I suppose that the very practical difficulty of doing that is that you are putting not only families in a very difficult position in a trauma unit but doctors too.  In practice, would you really want to have a system that puts families and doctors in conflict?  In the scenario where families do not give consent in a trauma unit or at the end of someone's life, you are potentially creating an opportunity for conflict between doctors and families, which is exactly what we want to avoid.

Claire Sugden: Yes, I accept that point.  If there were a provision that ensured that a deceased person's wishes were fulfilled, perhaps that would take away the conflict. No one could argue with it in that respect.  It is how you put that into practice.  Logistically, a last will and testament would not work, because there is just no time, but I would be interested to see how that could be considered through Consideration Stage.
It is true to say that the current system is not stimulating the conversation.  I am keen to understand how the new system would stimulate the conversation.  My understanding is that it would become the norm that, in the event of someone's death, they would donate unless otherwise stated or if the family did not want them to donate. Are we stimulating the conversation around the family having to make a decision that had not been discussed prior to the person passing away?  I have a bit of a reservation about that, because it even alludes to some of the points that Mr Ross has raised.
My final point is that Northern Ireland is a generous country.  We are the leading country for living donation, but that does not seem to be reflected in deceased organ donation rates.  For me, the difference seems to be consent and who gives it.  If both systems require family consent and the ultimate variable is family consent, why do we need to change the system?  Again, it comes back to the awareness campaign and how effective that will be.  If awareness campaigns do not work currently, will we have an awareness campaign that will be effective in upholding the legislation? They are dependent on one another.
There are many questions to be raised around organ donation, but, ultimately, I come back to the overarching principle.  This is an opportunity to save more lives, I know that we have to put more into that than just that one notion, but it is a notion that will be dictated by everybody's lives and the decisions they make.  I have no issues at this stage saying that I support the Bill, but I will look for it to be strengthened in the other arguments that I have presented.

Simon Hamilton: I am grateful for the opportunity to contribute, to respond to some of the points that were made in the debate, to set out the work that is being done by my Department and to explain my position on aspects of the Bill.  I acknowledge the Member for Upper Bann's achievement in bringing her Human Transplantation Bill before the Assembly and her contribution to raising awareness about organ donation.  I know that she has strived for this, and I share her aim of seeing many more of our fellow citizens who need an organ to improve their health or, indeed, in many cases, to save their life receive that organ at the earliest opportunity.
This year marks 21 years of the NHS organ donor register.  In the last 21 years, more than 55,000 people across the United Kingdom have received an organ transplant thanks to someone donating when they died.  A total of 21 million people across the United Kingdom have registered to help others.  At 30 September 2015, 647,237 people residing in Northern Ireland were on the UK organ donor register.  That is approximately 42% of the adult population.  The number of registrations per year on the organ donor register has increased from 16,657 in 2010-11 to 36,111 in 2015, so the number of people registering is rising considerably. Those are remarkable achievements, and Northern Ireland has played its part in the success of the organ donor register.  That is why I ask Members to think very carefully about giving their support to the Bill, because it proposes that, in future, in Northern Ireland, we will move from a tried and tested voluntary registration system to a statutory soft opt-out system of organ donation.  That would be a major change in our long-standing approach to organ donation. In doing so, the Bill raises important issues of ethical, legal, medical and social significance that require careful consideration by the Assembly.
Laudable as the Bill's aims are — none of us would disagree with the objective of increasing the number of donors who could help to save lives — the Bill asks the Assembly to take something of a leap in the dark, because we have no way of knowing what the impact of the Bill will be.  There is no clear evidence that a statutory approach will deliver significantly higher rates of donated organs than we have today.  In fact, while Spain, which has been much mentioned during the debate, is recognised as having a higher number of donors than the United Kingdom, it does so without having an opt-out system.  It legislated for one but never properly or fully enacted it.  Going by 2013-14 statistics, Northern Ireland's donor per million figure is also higher than those of many countries around the world — like Estonia, Austria, Italy and Finland — that have opt-out or deemed consent systems.
Until this year, we have never had a statutory requirement anywhere in the United Kingdom to make clear our wishes about donating our organs after death.  While the Bill makes provision for families to have the last say in the clauses covering deemed consent and affirmation, even with those safeguards, the Bill, if enacted, will introduce a fundamental change to our organ donation policy in Northern Ireland.  These are radical changes, and I fear that the proposed move to statutory soft opt-out could undermine the achievements of the last 21 years by making organ donation a controversial act rather than the act of generosity that it is today.  I know that some will say that, if a statutory soft opt-out system saves even one additional life, it is a step worth taking: I would reply that the success of the voluntary system of registration over the past 21 years should not be changed without careful consideration of the potential consequences.
My Department's policy is to fully implement the NHS Blood and Transplant strategy on organ donation.  The strategy does not propose that soft opt-out legislation should be introduced as a UK-wide policy.  The strategy aims to raise awareness and increase the number of donors and donated organs through society and individuals, NHS hospitals and staff, NHS Blood and Transplant and commissioners working together to achieve the desired outcomes.  My Department is committed to working with our partners in England, Scotland and Wales to achieve NHS Blood and Transplant's overall aim, which is for the United Kingdom to match world-class performance in organ donation and transplantation.  Given that the NHS Blood and Transplant strategy does not propose that soft opt-out legislation should be introduced as a UK-wide policy, I ask Members to consider whether the introduction of the Bill is premature.
I say that because we will have the opportunity to learn from the impact that statutory soft opt-out will have on organ donation in a part of the United Kingdom when this system comes into operation in Wales next month.
Northern Ireland and Wales operate their organ donor awareness and transplantation service under the United Kingdom's NHS Blood and Transplant partnership, as do England and Scotland.  Northern Ireland and Wales have been members of this successful partnership, which, in the past 21 years, has enabled 55,000 people across the UK to receive an organ transplant.  Northern Ireland and Wales have a similar culture that shapes social attitudes towards organ donation. We also have the opportunity in the months ahead to assess the impact that the NHS organ donor register, launched in July, will have.  The new register extends the choices that a person can record when they sign it.  Previously, we could register only to be an organ donor: the new register provides options to formally register our wishes to be a donor or not to be a donor and to record the details of two representatives to make the decision for us after death.  The new organ donor register has, therefore, given us the ability to voluntarily opt out and to nominate named individuals to make the decision to donate or not to donate our organs.
Let us not rush to legislate when we have the opportunity to learn from the experience in Wales and the impact of the new organ donor register in the months ahead.  If statutory soft opt-out significantly increases the number of donors and transplants in Wales, many may wish to consider legislation more favourably; if it makes little or no difference, the cautious approach that I advocate will be seen to have been prudent and sensible.
Having made clear my views on the central principle of the Bill and before I make some comments about its content, I would like to say a few words about the team that would be required in part to deliver the Bill in our hospitals if it becomes law.  I visited the regional centre for renal medicine and transplantation in the Belfast Trust and met the excellent team that provides that life-saving service.  They are an impressive group of professionals.  In my time as Minister, I do think that I have met a group of clinicians more dedicated to their work and less afraid to tell you that they want to be world-class. The world-class nature of the service was clearly seen on 13 September when a record five kidney transplants took place in less than 24 hours.  That falls just one short of the world record of six transplants in a day, in Texas in 2013, and equals the UK record of transplants performed in a single unit on a single day.  A team of 14 doctors, 20 nurses and three scientists were critical to the effort.  Notably, several operating theatre nurses came into work on their day off.  I am sure that the Assembly will join me in paying tribute to their remarkable skills and dedicated service to their community.  They are a truly amazing team of professionals whom we ought to be immensely proud of.
I have given my view, but, on a subject as serious as this, it is of paramount importance that we hear loudly and clearly the views of clinicians.  Whatever we feel about the Bill, they will have to operate with the legislation that we might pass.  The consultants in the aforementioned regional centre for renal medicine and transplantation in Belfast City Hospital collectively as one wrote to me to express their common position on the Bill.  Their views are worth hearing, so I will read their letter in full and will publish it on the Department's website as well as placing a copy in the Assembly Library. The letter reads:
"Dear Minister,

The Belfast Health and Social Care Trust, as providers of the only solid organ transplant service in Northern Ireland, have an obvious interest in the above proposed legislation in relation to organ donation. While fully supportive of the principle of increasing the number of deceased donor organs available to provide life-saving transplantation, we are cautious about any change which, although well-meaning, might potentially have a detrimental impact on the public's willingness to donate.

There are differing opinions within both the medical profession and society at large with regard to the acceptability of an opt-out system.  The perception by some that this effectively means acquisition by the state of body parts, and removal of the altruistic aspect of donation, is of concern.  These and other ethical issues have prevented the global adoption of presumed consent legislation."
The letter goes on:
"The Public Health Agency's research in 2013 on public attitudes to organ donation and transplantation revealed a high level of misunderstanding about organ donation.  However, the number of living kidney donors per million of population in Northern Ireland is over twice the UK average and is comparable to the highest international living donor rates.  This reflects the generosity of the population here and, with understanding of the issues, a very positive attitude towards transplantation.  With further public education, it is probable that there will be a better and more widespread willingness to increase deceased organ donation and that an understanding of the benefits of legislative change would also be achieved and accepted.

The higher rate of organ donation in opt-out jurisdictions persists, even when the next of kin are still asked for their approval before donation.  Rather than enforcement of a legislative decree, the increase in deceased donation in this setting reflects increased public awareness, societal attitudinal change to donation and improved infrastructure."
The letter then concludes:
"We suggest, therefore, that hesitation may be appropriate at this time.  Deferring any change would allow firstly for re-evaluation of the impact of the Public Health Agency's public education campaign and secondly, assessment of the impact of a similar change made by the Welsh Assembly which will take effect on 1 December 2015."
That letter is signed by the consultant nephrologists and transplant surgeons at the Belfast Health and Social Care Trust.
They are lengthy, but powerful and important words and we should listen to them.  Two sections of the letter stand out for me.  First, the clinicians state, and I repeat:
"While fully supportive of the principle of increasing the number of deceased donor organs available to provide life-saving transplantation, we are cautious about any change which, although well-meaning, may potentially have a detrimental impact on the public's willingness to donate."
I am sure that none of us, least of all Mrs Dobson, wishes to have a detrimental impact instead of a beneficial one.  However, that is what the consultant nephrologists and transplant surgeons at the City Hospital fear, and that should sound a note of caution.
I understand their point about a potential negative impact.  At present, regardless of the register, 100% of individuals are potential donors and specialist nurses and clinicians have to have the extremely sensitive and difficult conversations with relatives after a death.  The experts fear that, if there is a level of backlash against legislation, a large number of people opting out from the outset, could limit that from 100% to, say, 70% or 75%.  Clearly, that would not be an outcome that any of us would want, but it is certainly a distinct possibility.  The Public Health Agency's evaluation work found that 6% of those currently on the organ donor register said that they would opt out of the system if it became mandatory.  Some 23% agreed that organ donation is a gift which the opt-out system will take away.  There is a worrying risk that a sizeable number will remove themselves from the register forever.
The second significant section in the letter surrounds the consultants' and surgeons' explicit care for caution.  They say:
"We suggest, therefore, that hesitation may be appropriate at this time.  Deferring any change would allow firstly, for re-evaluation of the impact of the Public Health Agency's public education campaign and, secondly, assessment of the impact of a similar change made by the Welsh Assembly which will take effect on 1 December 2015."
Clearly, they are urging caution; a wait-and-see approach, not ruling out legislation forever, but urging us to defer change.
This is undoubtedly an emotional issue, but that does not mean that we can or should simply ditch evidence.  On a range of issues, I have found that, as Minister of Health, I am encouraged by others to set to one side my personal beliefs, wherever they might emanate from, and follow the science and the evidence.  On an issue as potentially far-reaching and controversial as this, we would do well to examine the evidence and listen to our clinicians.  Views like those recently expressed by Professor John Fabre, of King's College, London, who wrote in the journal 'Clinical Evidence' that:
"there is scant evidence that presumed consent will be effective."
So, regardless of whether the Bill passes its Second Stage, I want to carefully consider the clinical view and the evidence about an opt-out system.  To that end, it is my intention to establish a working group that will do just that:  consider what clinicians believe is best, and examine the available evidence about an opt-out system.
Should the Bill pass its Second Stage today, that view will be more important than ever.  If it does not, I am still prepared to work with our clinicians, especially as we will have evidence from Wales's experience to consider.
I will now make some comments on the detail of the legislation.  If it becomes law, the Bill will have significant implications for my Department's organ transplantation policy and for everyone in Northern Ireland.  We must therefore ensure that it provides maximum clarity about the donation and use of human organs in transplantation.  That will be of concern to all in Northern Ireland, who in the future may be faced with making decisions on the donation of their loved one's organs.
If the Bill completes its Second Stage today and moves to Committee Stage, appropriate and sufficient time must be given to scrutinising a Bill of such importance.  I know that the Committee has a busy workload at present, and giving the Bill sufficient and appropriate scrutiny could mean that other legislation falls.  I have heard it suggested that the Committee Stage be expedited or that all evidence sessions be held on one day.  That would be a mistake.  It would not reflect the seriousness of the legislation, nor would it permit proper scrutiny.  It would not inspire public confidence in the outcome either.  I look to the wise judgement of the Committee Chair and members to ensure that the Bill gets the most robust scrutiny.
We need to ensure that the Bill gives clear direction on the regulations to be made by my Department in subordinate legislation.  Those regulations are required under clause 7, which deals with express consent to transplantation activities involving excluded material, clause 8, which deals with deemed consent to activities involving material from living adults who lack the capacity to consent, and clause 9, which deals with appointed representatives to express consent for transplant activities.  Clause 9 is especially important, where the individual concerned may disagree with the views of appointed representatives on organ donation.
In deemed consent cases, the individual specified through qualifying relationships in clause 10 will be an important reference for the necessary information about the views of the potential donor in order to ensure that the donation does not go ahead if the deceased had a known objection to organ donation.  Deemed consent as described in the Bill is at the heart of some of the most difficult conversations that any family might face.  We must therefore ensure that the Bill provides appropriate safeguards in that sensitive area.  One aspect of clause 4 in particular concerns me and needs more consideration and is to do with the designation of a "friend of long standing" in clause 10(1)(h).  Nowhere in the legislation does it detail what a "friend of long standing" is, what counts as long-standing or what constitutes a friendship.
Clauses 5 and 8 are also important, owing to their ethical intent.  The clauses cover issues concerning the capacity of individuals to consent and, again, need to be clear and easily understood.  They also need to be considered in the context of the Mental Capacity Bill, currently under consideration by the Assembly, to ensure consistency of approach.
The schedule to the Bill proposes extensive amendments to the Human Tissue Act 2004 and the related codes of practice issued by the Human Tissue Authority.  If the Bill passes to Committee Stage, my Department will need to consult the authority fully on those amendments, as its codes will provide guidance on the implementation of the Bill's amendments to the 2004 Act.  My Department believes that it will be essential for it also to produce a code of practice to ensure that guidance on the new transplantation policy proposed by the Bill is available for healthcare professionals, patients and their families — guidance that they can easily understand and apply at hospital level.  In addition to the codes of practice, there are other important operational matters that will require careful consideration.  Those include an assessment of the impact on critical-care capacity in our hospitals of an increase in the number of donors.
Clause 1 in the Bill places a duty on my Department to promote organ donation in a campaign at least once a year that informs the public about the circumstances in which consent to transplantation is deemed to be given and the role of relatives and friends in affirming deemed consent.  The campaign should also increase awareness about transplantation.  My Department has estimated that the annual recurrent cost of that campaign could be in the region of £250,000.
I understand that the Member for Upper Bann has said — indeed, she repeated it today — that information available to her indicates that the cost of implementing the Bill is likely to be between £2 million and £5 million.  In 2012, the Welsh Government estimated that the cost of implementing similar legislation in Wales would be £8 million, discounted over 10 years.  On a population-proportionate basis, the estimated cost of implementing the Bill in Northern Ireland is therefore £5·3 million when inflation is taken into account.
That estimated cost would cover new investment to set up and maintain the infrastructure required to operate a statutory soft opt-out system of organ donation.  The costs would include business and system changes, the processing of opt-out requests, public communications and evaluation.  In addition to the new investment in infrastructure, costs would also likely be incurred from any increase in the number of organs retrieved from deceased people and transplanted.  Those are variable costs that will differ by organ type.  Currently, my Department contributes in the region of £2 million annually to NHS Blood and Transplant, including for the retrieval and transport of organs given by donors in Northern Ireland that are clinically suitable for patients awaiting an organ in the rest of the UK.  My Department would therefore need additional resources to implement this Bill.
I think that legitimate questions exist about the human rights compliance of this legislation, and I will be seeking the Attorney General's view about that important aspect.  I hope that the Assembly will see from my comments that, if this Bill passes to Committee Stage today, the Committee will need to ensure that the content of the Bill is clear and leaves no room for ambiguity in its interpretation if it becomes law.
I have raised some important points of caution.  I have also set out the views of clinicians as they have conveyed them to me.  I want to set out my own position on the Bill.  I said at the start of my speech that I share the aim of the Member for Upper Bann to see many more of our fellow citizens who need an organ to improve their health, and, indeed, in many cases, to save their life, receive that organ at the earliest opportunity.  The debate around this Bill has made me think about the issue in ways that I had not thought about it before.  It has provoked not just my own thinking, but conversations in my family.  I have, for the first time, signed up to the organ donor register.  While I may have some misgivings about the Bill, it has at least made me see the merits of voluntarily signing up to the register.
My predecessors and I have previously stated that making a decision on any legislative change for organ donation is not one to be taken lightly, just as an individual's decision to go on the organ donor register should not be taken lightly either.  The last place we want to be is, in seeking to do the right thing for the right reasons, actually doing the wrong thing.  That remains my position.  It also appears to be the view of clinicians.
The new organ donor register also needs time to establish public awareness of the additional registration options.  It is hoped that the new register will encourage more people to donate their organs and to make their wishes clear.  I firmly believe that my Department’s policy of increased public awareness, education on the key issues, promoting the new organ donor register and the further development of transplantation services through UK-wide action is the best way forward for organ donation in Northern Ireland.
I believe that it would be better for this Assembly to wait and see the impact of the introduction of the statutory soft opt-out system in Wales next month.  As it stands, this legislation would come into full operation on 31 May 2018, regardless of the Welsh experience or the clinical evidence available between now and then.  I do not believe that either can be ignored.
I will listen very carefully to Mrs Dobson as she concludes the debate.  She exhibits a willingness to accept the need expressed by the team of consultants at the renal transplantation centre that waiting and seeing is the best course of action.  If she is willing to embrace the need to reflect this in her Bill by way of an amendment, in spite of my serious concerns, I am prepared to work with the Member and make resources from my Department available to craft the Bill into one that is workable and that reflects the need to consider the views of clinicians, the evidence available and the experience in Wales, should the Bill pass Second Stage today.
For our part, my senior official who is leading on this issue has already met Mrs Dobson to indicate my Department's willingness to engage with her because, believe me, this Bill needs some work.  There are too many elements of the Bill that are too unclear and uncertain in such an incredibly important and potentially controversial piece of law.  Just a few days ago, the British Medical Association, which had been supportive of the Bill, wrote to all MLAs expressing concerns about clause 4, stating its belief that the current drafting "could lead to confusion".  Whenever supporters of the Bill are sounding notes of caution, we should respect that and reflect it in our scrutiny.
I believe that it is critical that we take our time, consider the clinical evidence and get this right.  If the Member for Upper Bann illustrates a willingness to work with me and my Department to make the legislation workable and reflect the fact that the experience of elsewhere must be taken into account before full operation, I will not stand in its way today.  However, if the legislation put before the House at a later stage is still concerning clinicians, I will revisit my position.
(Mr Principal Deputy Speaker [Mr Newton] in the Chair)
Strong views on either side of the argument clearly exist in the Chamber, just as they will exist in our community.  As we move forward with the issue, I caution that those who oppose the Bill today are not pilloried as being against organ donation.  Quite the opposite is true, I am sure.  Concerns about the state overreaching or adding stress to bereaved families at a very difficult time are entirely legitimate and should be respected and not characterised as being against organ donation or opposed to more donors.
It is an incredibly important issue, deserving of mature debate and careful consideration.  I urge the House to debate the issue intensely but without rancour and to carefully consider the issues raised today.

Jo-Anne Dobson: It certainly has been a marathon debate.  I thank all those Members who spoke during it.  In opening the debate, I said that I rose first as a mother of a successful kidney transplant recipient, and it is in that spirit that I wish to continue to speak in closing the debate.  I repeat my offer to continue to work with any Member on any aspect of the Bill.  That has always been my intention.
I well remember the Health Minister's immediate predecessor predicting in the Chamber earlier this year that this debate would be:
"a very interesting test of the maturity of the Assembly." [Official Report, Vol 102, No 2, p29, col 2].
That is one prediction that has certainly come true.  I thank Members from across the House for their contributions.  As I said earlier when talking about organ donation, there is always a need for emotion and sensitivity, and we have certainly had a considerable amount of both in the debate.  I am thankful to Members for that.
We have heard much in the House about the Donaldson report in the last couple of weeks.  I would like to reference Sir Liam in relation to his views on organ donation.  In 2007, the then Chief Medical Officer was at pains to point out that, as we face an ageing population, the demand for organs will inevitably increase.  That is an important point, which I do not believe can be overemphasised, especially with recent research from Age UK, which has been raised in the House in relation to other issues.  It shows that the number of people over 85 in the United Kingdom is predicted to more than double in the next 23 years to over 3·4 million people.  That will inevitably have an impact on our services here in Northern Ireland.  As I said earlier, when viewing the Bill, we should look at the position we want to be in in five, 10, 15 or even 20 years' time.
Those figures are to be welcomed and celebrated, but an ageing population will inevitably continue to put pressure on the demand for organs.  Sir Liam said:
"People are dying, people are suffering and many people are living on a knife-edge of despair waiting for a phone call that never comes.  My view has always been that we need to act with solidarity, generosity and humanity to give these people a future."
Those comments were made eight years ago.  As Sir Liam is a senior medical expert, I welcome his continued support for the soft opt-out system and recognise that he supports, as I do, the key role that the family has to play in that system.  All too often when we plan, we do not lift our heads to the future.  Dealing with the here and now often becomes more important and pressing.  On an issue like organ donation, it is very clear, and has been said again today, that change does not and cannot happen overnight.  It is a process.  It requires careful planning and a vision for the future in, as I said, five, 10, 15 or 20 years' time.
When our fantastic clinicians were pioneering surgery at the City Hospital in the 1960s, 1970s and 1980s — I think particularly of Professor Mary "Mollie" McGeown CBE, whose portrait still hangs proudly on the eleventh floor — little did they think that medicine would move on quite so dramatically.  Professor McGeown proudly oversaw the opening of a purpose-built transplant unit at the City Hospital in 1968, and a dialysis unit was established on the same site the following year.  Countless local lives have been saved in the 47 years since, and the unit that she proudly oversaw has changed dramatically since that time.
Equally, I know that we now have the ability to transplant organs that may have previously been rejected as unsuitable or too risky.  That was highlighted vividly in a recent BBC Scotland programme entitled 'Transplant Tales, Life on the List'.  The programme made for compelling viewing and was a regular fixture in our house, watched several times on the iPlayer.  It looked at the challenges of an ageing population and issues including alcohol, obesity and, specifically, the alarming rise in diabetes.  It concluded that, due to those and other issues, the demand for transplant organs is, in the words of the programme:
"set to explode over the next ten years."
It also highlighted the already critical shortage of organs and that three people in the UK die waiting for a transplant every single day.  The two-part documentary had exclusive access to Scotland's entire transplant service, and I commend it to Members as compelling viewing on the issue of organ donation and the very human aspect to the ever-growing number of patients whose lives are on hold, desperately waiting for an organ to become available.
As a lifelong supporter of organ donation, I have been heartened by comments that have been made in the Chamber by successive Health Ministers.  These included comments on 5 February 2013 after the First Minister and deputy First Minister gave their support to the soft opt-out system alongside the then Health Minister, Mr Poots.  In responding to a question that I asked that afternoon, Mr Poots said:
"I believe that we can continue to drive organ donation upwards.  I believe that an opt-out scheme can help maximise that, and I believe that an opt-out scheme with a strong educational emphasis will fully maximise the number of organ donations that we have in Northern Ireland." — [Official Report, Bound Volume 81, p254, col 1].
Those words stand as true today as they were two years ago.  I hope that Members realise that this Bill includes the all-important education programme that he spoke about.
Equally, I was heartened by the very open debate that took place in the Chamber in February 2012.  Member after Member, from all sides of the House, reiterated their support for organ donation, and issues about the opt-out system were raised in what was a very measured and tempered debate.  In his contribution to the debate, we received what I believe was an important commitment from Minister Poots.  He said that he was of the opinion:
"we need to do more in respect of retrieving and transplanting organs for those who need them." — [Official Report, Bound Volume 72, p73, col 1].
In making the winding-up speech for that important debate, Ms Paula Bradley said — and I could not agree with her more:
"We as an Assembly should work towards ensuring that we can perhaps first follow the Welsh example of changing our current opt-in system to one of the two opt-out systems in place in 22 other countries." — [Official Report, Bound Volume 72, p75, col 2].
That, Members, is what I am asking of you today:  that we work together to achieve the right Bill for Northern Ireland.

Ian McCrea: Will the Member give way?

Jo-Anne Dobson: No, I have already given way plenty.
I have long said that I believed that the Executive should bring forward the legislation, and that it should not be left to a Back-Bencher such as me to do so, although I remain completely committed to seeing it through.  No one would have been more delighted to have seen the Bill taken up by the Executive and, indeed, I believed that it was going to happen on a number of occasions.  Indeed, when I met the First Minister and the deputy First Minister jointly on the issue in March of last year, I raised the matter of resources, given their public support for the soft opt-out system.  I remain hopeful that I will be given the opportunity to work alongside the Department of Health as things progress.
A number of Members raised the British Medical Association, and I welcome continuing to work with it.  I have indeed been in contact with it to set up a meeting in the coming weeks to discuss the Bill.  I mentioned earlier that I am also looking forward to a fruitful working relationship with the Department of Health, and I welcomed the opportunity to meet with the director just two weeks ago.
I turn to individual contributions by Members, and there were many.  Maeve McLaughlin's was the first.  I thank the Chair for supporting organ donation events with charities in this Building, and I welcome her support for transplant awareness week.  During her speech, the Chair gave us an overview of the Committee evidence session and highlighted what she called the stark reality of 15 people dying, and that rose to 17 last year.  She acknowledged that the Bill has the potential to touch every one of us.  Importantly, so too does the issue of organ transplantation.  I agree with her that consent is a difficult issue, especially for grieving families.  However, it is made a little easier when they know what the wishes of their loved ones were.  She referred to the important role of clinicians, but that is to advise and not to take decisions on consent.  They are very clear on that.  She highlighted that no one could put a financial figure on good health.  I agree with her comments about education and communication being crucial cornerstones of the Bill.
I am thankful to the Deputy Chair, Mr Easton, for his contribution to the debate and, at the outset, his open-mindedness as the Bill goes forward.  I also welcome his recognition of my extensive consultation and overview of the Bill.  Mr Easton spoke about medical opinions on the Bill.  I understand that that is exactly what the Committee Stage can achieve and welcome his role in this as Deputy Chair.  Finally, I refer to his comments on organs being made available to patients across the United Kingdom.  My son Mark's kidney came from England.  Mr Easton's colleague Mr Poots, when Minister, recognised that we benefited hugely from that relationship.
The third Member to speak was Fearghal McKinney.  He poignantly asked us to consider those lost lives, and that is exactly what we should be doing.  I am grateful to the support provided by Mr McKinney and Members of his party for organ donation events in this Building.  I am also grateful to Mr Ramsey and, previously, Mr McDevitt for their roles as vice-chairs of the all-party Assembly group on organ donation.  I understand that Mr McKinney has asked a number of questions for written answer, and I feel that he has touched on very important issues here.  He spoke about an important balance that needed to be struck and supported the role of advocates.  I thank him for his support and kind comments, and I agree that there will be major moral, ethical and legal issues as the Bill proceeds.  I welcome his commitment to the inclusion of safeguards.  I welcome Mr McKinney's recognition of the work that been undertaken and his focus on finance and cost savings.
The next Member to speak was Michael McGimpsey, who referred to the prize that we will get out of this and the fact that this is ground-breaking.  I thank Michael for his important support for the Bill; his insight as a former Health Minister has been crucial in bringing it forward.  I will try not to embarrass him too much, but I remember being with Michael back in 2009 at the opening of the Wellbeing and Treatment Centre at Forestside.  Mark and I were there with an army of organ donation volunteers, raising awareness and funds.  Mark was not long after his kidney transplant, but, as always, he was there with me, by my side, and I was delighted with the support that Michael showed us that day.  It was a shot in the arm for us volunteers to know that we had the support of the Health Minister.  It meant a lot then and does to this day.
Very poignantly, Michael mentioned the loss of children with their entire life ahead of them and said that the greater availability of organs would increase life chances for seriously ill children.  By facing serious issues raised in the Bill, we are actually saving lives.  Not going forward will be to the detriment of patients, especially the young children whom Michael referred to.  In principle, for the prize and what we will get out of it, we should get behind the Bill.  I thank him for his contribution.
Stewart Dickson talked about his experience of early heart transplant recipients and said that their lives were extended as a result of organ donation.  He also spoke about a friend who had received a second kidney transplant — someone who has returned to as normal a life as possible.  I thank Mr Dickson for his comments and for what he said about the meticulous research on the Bill.
Gary Middleton is the newest member of the Health Committee, and he is welcome.  He referred to the varying systems across the world.  I agree fully with him that the personal stories bring it home to all of us.  He talked about Andrew Duncan and his untimely death one year ago today.  Andrew was scheduled to present to the all-party group last year, but, sadly, his illness prevented him from doing that.  I had the immense privilege of meeting his wife and viewing the video that the British Heart Foundation brought to the all-party group.  I also agree with Mr Middleton that Andrew's story and other emotional stories highlight the current situation.
I agree with Rosie McCorley about this being an emotive issue.  According to Ms McCorley, due to the lack of available donors, soft opt-out is the right way to go.  She referred to the presentations made to the Committee by those whose lives were changed by organ donation.  She also referred to the number of people who die each year, and she encouraged Members to support the Bill and for the public to have that conversation.
Pam Cameron said that organ donation was an issue for further debate and that she had real concerns with the Bill.  I say to the Member that the central issue should be carrying out the will of the deceased.  She also said that any legislation introduced in the wrong way could be detrimental to our constituents.  I recognise some of her concerns, but would say, as I have always said, that I am willing to work with her as the Bill proceeds in Committee.
I welcome Pat Ramsey's contribution and his willingness to see the Bill go forward to Committee Stage for scrutiny.  He referred to personal stories and talked about the clear support in Northern Ireland for the change to the soft opt-out system.  He referred to the 162 people waiting for transplants and encouraged Members across the Chamber to meet me.  As I said, I wrote to Members in 2013 offering that opportunity, and my door remains firmly open.
Daithí McKay talked about the cultural changes that have occurred in other countries.  He described the Bill as one of the most important in this Assembly term, and I appreciate that, given his record for private Members' Bills.  He said that lives were at risk and the proper thing to do was to allow the Bill to proceed to Committee.
I have trouble with Alastair Ross's concerns about ideological difficulties, especially as, I am sure, he probably knocked on the doors of the East Antrim constituency for Sammy Wilson's 2010 Westminster campaign, when there was a commitment in the manifesto to support presumed consent; not soft opt-out, but presumed consent.  If it was so right for the people in 2010, why is it so wrong for them five years later?  Alastair said that legislation was unnecessary and possibly counterproductive, but he congratulated me on bringing the Bill to this stage.  I agree with him that the most important thing that we can do is to discuss the issue with our loved ones.  He told us about his strong, fundamental opposition to the Bill and said that he will oppose it at this stage, which, naturally, disappoints me, given his previous stance of wishing to bring forward legislation on this very issue.
I wish to correct the Member.  During his contribution, he said that the second PHA consultation showed a drop in public support.  It did not; it went up from 56% to 61%.  The Member said that he supports —

Alastair Ross: Will the Member give way?

Jo-Anne Dobson: No, I want to make my points.  You have spoken quite a lot.
The Member says that he supports my aim of increasing the number of donors, yet he wants to put the brake on the only Bill brought before the House that seeks to do so.  The Member talked about Brazil and the public mistrust around the issue of abuse of organs.  I hope that he is not for one second suggesting that we have, or could ever have, that situation.  I am sure that his colleague the Health Minister would be gravely concerned if he is.
The Member said that he opposed the Bill and proceeded to go through his thoughts on how it should be approached at Committee Stage.  On the RaISe document that he mentioned, does he agree that, had there been a greater level of support and openness from the Department, we could have had greater knowledge of the costs at this point?  That paper is available in the Assembly Library.

Alastair Ross: Will the Member give way?

Jo-Anne Dobson: No, I am making my points.
The Member would, of course, have had the opportunity to commission his own research for his own Bill.  I agree with him that I would have preferred to see action from the Department, especially given the support from the First Minister and the deputy First Minister.
Steven Agnew stated the support of the Green Party for the soft opt-out system and said that he had tabled a number of questions for written answer on the issue.  I welcome his recent support for transplant awareness week, when he took the time to meet the charity volunteers in Room 115 to support their cause.  He referred to organ donation as —

Alastair Ross: On a point of order, Mr Principal Deputy Speaker.  I fully acknowledge that it up to Members to decide whether they give way in a debate, but is it in order for a Member to ask a specific question of another Member and then refuse to give way?

Some Members: Hear, hear.

Robin Newton: It is entirely in the gift of the Member speaking.

Jo-Anne Dobson: Thank you, Mr Principal Deputy Speaker, for clarifying that.
As I said, I welcome Mr Agnew's recent support for transplant awareness week.  As he said, I will work with anyone to get the right Bill for Northern Ireland, and my door has been firmly open.  I would welcome Mr Ross taking the opportunity to come to speak to me as the Bill progresses.
Mr Agnew said that organ donation is one of the wonders of modern science, and he spoke of William Johnson, who has waited 17 years on a kidney.  He hopes that this opportunity will not go to waste.
John McCallister has been supportive of the Bill from the beginning, and I appreciate his comments, not least because he knows what it is like to bring through a private Member's Bill and the hours of work that it entails.  Just like my Bill, his looks to the future — five, 10, 15 and 20 years down the line.  It is interesting that such far-reaching issues are being brought through as private Member's Bills, not by the Executive.  John spoke about having important discussions over the dinner table.  I welcome his contribution.
Claire Sugden raised some very important points.  I welcome her support and look forward to working with her as the Bill progresses.
I was disappointed by the Health Minister's "leap in the dark" comment.  It is hope that we should be seeking to give our constituents, and consecutive Health Ministers have taken the stance of researching continually rather than taking action, one minute seemingly supporting soft opt-out and the next minute opposing it.  The Minister's position seems to be to wait and see whether lives are saved in Wales, and then, when he finds out that they are, to act here.  That will be disappointing to campaigners and charities.
In reply to a question for written answer in October 2014, Jim Wells said that he would make a decision on whether to bring forward statutory opt-out legislation once he had reviewed the second PHA survey.  I welcome Jim's contribution today.  Given that the survey shows an increase in public support for soft opt-out legislation, it would be helpful to know whether the Minister takes the same decision that his predecessor took.

Simon Hamilton: Will the Member give way?

Jo-Anne Dobson: Yes.
[Interruption.]

Simon Hamilton: I must be privileged, Mr Principal Deputy Speaker.  The Member stated my view.  Does she accept the important letter that I read into the record, which will be available on the Department's website and in the Assembly Library.  It states that it is the view of the clinicians and consultants in the transplant centre at the Belfast Trust that we should be cautious, wait and see and view the Welsh experience before moving forward in Northern Ireland?  Does she accept that that is their view?

Jo-Anne Dobson: I very much look forward to reading the letter.  I want to put it on record, Minister, that we have not been able to get an appointment for a meeting yet.  The previous one was cancelled: could we slot that in very soon?
It only remains for me to thank all Members who contributed.  I repeat: my door remains open.  I have listened carefully to all the points that have been raised and I give an undertaking to carefully consider the points raised by Members.  Each donor, as has been said, can save up to seven lives.  I know so many families, some of whom have lost mothers, fathers, sons, daughters or grandparents, who take great comfort every day from the fact that their loved one allowed someone else to live.  I can think of so many cases where that is true.  We in the organ donation family hold each and every one of them up as heroes.  I mentioned in my earlier contribution the importance that Dame Mary Peters attaches to donor families.  It is fantastic that she recognises them every year and that it is an extremely important issue for her.  I welcome Dame Mary's support, alongside so many from the world of sport, including the support of the IFA and particularly Gerry Armstrong; Joe Brolly and the GAA; and Ulster Rugby, which has been assisting and helping to promote the move to a soft opt-out system.
I will leave the final word to the charities —

Alastair Ross: Will the Member give way?

Jo-Anne Dobson: I am nearly finished my comments.
We are blessed in Northern Ireland to have so many amazing people promoting and supporting organ donation, people who do the work not for financial reward but quite the opposite —

Alastair Ross: On a point of order, Mr Principal Deputy Speaker.  The Member has just indicated that Ulster Rugby is supportive of a move to soft opt-out: that is not the case.  Perhaps Mrs Dobson will use the opportunity to correct the record.

Jo-Anne Dobson: No, I will not correct the record.
I will leave the final word to the charities.  As I said, we are blessed in Northern Ireland to have so many amazing people promoting and supporting organ donation, people who do the work not for financial reward but, quite the opposite, because they truly believe.  They believe that it is their duty to promote organ donation and to tell the human stories of pain and joy or, in the case of our four local transplant athletes — Philip, Catherine, Kathryn and Matthew — to compete and win on the world stage and honour their donors through sport.
For decades, transplant volunteers were the small but ever-increasing band of voices shouting out for organ donation in Northern Ireland.  Why?  Because they were touched by it and they knew what it meant to be waiting and for them or a loved one to receive a life-saving transplant.  I am extremely proud to count myself amongst their number.  They spread the word, whether among students or the general public, that any one of us at any time may need a life-saving transplant.  They have also been vigorous supporters of the all-party group, attending regularly or, on a number of occasions, presenting.  I have heard charity volunteers on so many occasions encouraging people to think about whether, if they are prepared to receive an organ to save their life, they are prepared to give an organ to save someone else's life.  That is the fundamental point.  From the bottom of my heart, I thank them for what they continue to do and for their support in bringing forward the Bill.
Our continued focus on organ donation at the Assembly highlights to government and those with responsibility that the issue can and should no longer be left solely to the charities.  Government has a key role to play.  That is why I support the PHA's Speak Up and Save a Life campaign so vigorously and have included an education programme at clause 1 for that very reason.  As I outlined earlier, the scheme would pay for itself through increased donations and decreased costs to the health service.
At a time of immense grief, a family whom we will never know gave me back my son.  That is why I stand here moving the Bill.  I want us to move to a position where organ donation is the norm in society and where not to donate is the exception.  This is a journey that we have already begun, but more needs to be done.  I submit that moving to a soft opt-out system will help to bridge the gap between the supply and demand for organs. I commend the Second Stage of the Human Transplantation Bill to the House and encourage Members to support it.
Question put.

The Assembly divided:
 Ayes 46; Noes 17
 AYES 
 Mr Agnew, Mr Allister, Mr Attwood, Mr Beggs, Mr Boylan, Ms Boyle, Mr Dallat, Mr Dickson, Mrs Dobson, Dr Farry, Ms Fearon, Mr Flanagan, Mr Ford, Mr Gardiner, Mr Hazzard, Mr G Kelly, Mr Kennedy, Ms Lo, Mr Lynch, Mr Lyttle, Mr McAleer, Mr McCallister, Mr F McCann, Ms McCorley, Ms McGahan, Mr McGimpsey, Mr McGlone, Mr McKay, Mrs McKevitt, Mr McKinney, Ms Maeve McLaughlin, Mr A Maginness, Mr Maskey, Mr Milne, Mr Murphy, Mr Nesbitt, Ms Ní Chuilín, Mr Ó hOisín, Mr Ó Muilleoir, Mr O'Dowd, Mrs O'Neill, Mrs Overend, Ms Ruane, Mr Sheehan, Ms Sugden, Mr Wells
 Tellers for the Ayes: Mr Kennedy, Mr Nesbitt
 NOES 
Mr Anderson, Mr Bell, Mr Buchanan, Mrs Cameron, Mr Clarke, Mr Dunne, Mr Frew, Mr Girvan, Mr Hilditch, Mr Lyons, Mr I McCrea, Mr D McIlveen, Miss M McIlveen, Lord Morrow, Mr Moutray, Mr Ross, Mr Storey
 Tellers for the Noes: Mr I McCrea, Mr Ross
 The following Members voted in both Lobbies and are therefore not counted in the result: Ms P Bradley, Mr Douglas, Mr Easton, Mrs Hale, Mr Hamilton, Mr Humphrey, Mr McCausland, Mr Middleton, Mr Weir
Question accordingly agreed to.

Resolved:
That the Second Stage of the Human Transplantation Bill [NIA 64/11-16] be agreed.

Robin Newton: That concludes the Second Stage of the Human Transplantation Bill.  The Bill stands referred to the Committee for Health, Social Services and Public Safety.
I ask Members to leave the Chamber quietly.

Scrap Metal Dealers Bill:  Second Stage

Roy Beggs: I beg to move
That the Second Stage of the Scrap Metal Dealers Bill [NIA 65/11-16] be agreed.
Before introducing legislation, it is important to assess whether there is a need for it and whether the proposal is workable and proportionate.  I hope to demonstrate that my private Member's Bill, which leans heavily on legislation that is already in place elsewhere, does so.
I live near Gleno in a rural community between Larne and Carrickfergus, and there have been a number of incidents in my local community that have shown me from experience that this has been a major problem.  First, in Gleno, a new set of street lights was installed by Roads Service to link the village to the local bus stop at McDowell's shop.  Within two weeks, the lights stopped working, and, when I enquired what the nature of the fault was, I was advised that thieves had stolen the underground cable.  This was at a cost to the public purse, with inconvenience and loss of service to the public.
My church, Raloo Presbyterian Church, was targeted, and the lead was stripped off the hall roof.  Through this, I learned that it is not just the discomfort of having your property attacked and the value of lead stolen but that there is the cost of weather damage to the interior of the building as a result of water ingress.  Then, again, there is the cost of repair for installing new material.  So, clearly, there is a need to address this issue.  Considerable costs are being incurred in the community as a result of metal theft.  Similarly, several schools in my constituency have been targeted — Greenisland Primary School, Downshire School and Ulidia Integrated College — disrupting children's education.
Equally, many private homes, social houses and businesses have suffered considerable loss and inconvenience, primarily around the issue of lead-flashing and copper-piping theft.  A few miles up the road from where I live in the Gleno valley, there lies the Ballyvallagh NIE electricity substation, which supplies electricity to much of Larne.  I discovered that, on two occasions, the copper earth cables had been stolen.  Those who carried out those thefts will have done so at considerable personal risk, and, in addition, the theft endangered the substation and could have resulted in significant failure and the subsequent loss of power for a considerable time to a wider group of constituents in the Larne area.
When I started to question where all this material was going, I became aware that it could be traded in Northern Ireland anonymously and for cash through scrap metal dealers and that no specific legislation existed in Northern Ireland around scrap metal dealers.  Criminals will be attracted to or deterred from a particular illegal act depending on the risks and rewards associated with it.  For a number of years in Northern Ireland, criminals have been able to prosper anonymously by selling stolen metal goods for cash.  If there is a low risk of being detected and an ability to make significant amounts of money, criminals will be drawn into this particular area of crime.  This was certainly true of scrap metal theft, particularly when prices peaked around 2011-12.  The level of reward is determined by market forces.  The value of scrap metal is set by the stock market, based on international prices of metal.  It is beyond our control, so we cannot control the rewards that criminals can obtain.
Therefore, I then started to look at the risk side of the equation.  How can we as legislators increase the risk of detection for those who steal metal when they go to sell it and profit from it?  By licensing scrap metal dealers, we will be able to increase the controls that will exist and increase the risks for those who wish to deal in scrap metal illegally.  By requiring a verification of the supplier's identity, an audit trail of those who provide the scrap metal to the dealer is created.  Therefore, metal thieves would face an increased risk of being identified.  This, of course, will deter them from stealing metal objects in the first place.  With a requirement of proof of ID, record of sale and vehicle registration, and the restricting of cash sales in favour of traceable bank transactions, the risk of a thief being identified will increase considerably.  Again, I argue that it will further deter metal theft.
There in a nutshell is the principle behind the Scrap Metal Dealers Bill.
What is the history of scrap metal dealers legislation?  In the 1960s, there was concern that metal goods were being stolen, so the Scrap Metal Dealers Act 1964 was introduced in England and Wales.  There was a fit and proper person requirement for those who wished to be licensed, and that was aimed at preventing criminals from stealing metal and profiting from recycling stolen goods.  With soaring metal prices over recent years, more criminals have been profiting from stolen metal, and the 1964 Act proved to be insufficient. In 2012, police in England and Wales led Operation Tornado, which introduced a voluntary scheme whereby many scrap metal dealers recorded the details of individuals who supplied metals for recycling.  Although many dealers joined the voluntary scheme, which helped to reduce crime, but many others did not.
That was followed by the Scrap Metal Dealers Act 2013, which started out as a private Member's Bill, I might add.  It made the recording of all scrap metal purchases compulsory and introduced a cashless system to better trace those profiting from the sale of scrap metal.  As a result of those changes, thefts of metal in England and Wales declined by one third between 2012-13 and 2013-14.  Interestingly, during the very same period as that reduction happened in England and Wales, there was an increase in metal thefts in Scotland, which did not have an equivalent scheme in operation.  It is thought that organised crime elements moved north to Scotland.  Scotland had the Civic Government (Scotland) Act 1982 governing the sale of scrap metal, which had similar provisions to the 1964 Act.  When that proved to be insufficient in Scotland, the Scottish Executive amended their scrap metal dealer legislation through the Air Weapons and Licensing (Scotland) Act 2015, which only recently received Royal Assent, on 4 August 2015.  That brought Scotland into line with the updated traceability requirements in the 2013 legislation that applies to England and Wales.
When I was considering legislation for Northern Ireland, I was unable to find any specific legislation regulating scrap metal dealers.  It would appear that, in the past, anyone could set up as a scrap metal dealer and there was no requirement to meet the fit and proper person requirement.  Indeed, there were no requirements under the older legislation, never mind the newer legislation that was recently updated.  Only environmental and planning regulations exist, imposing restrictions in those areas. We have no scrap metal dealer licensing in Northern Ireland and we are the only part of the United Kingdom without scrap metal dealer licensing and a mandatory traceability scheme involving scrap metal dealing.
I am aware of a concern about the effect of having different rules on either side of the border and how that will potentially distort business.  I will come back to Northern Ireland shortly, but I want to update Members on issues that I discovered regarding the Republic of Ireland.  I noticed that it, too, had been suffering from a considerable number of metal thefts.  In 2012, the Irish Farmers' Association called for the introduction of a track-and-trace scheme to curb scrap metal and machinery thefts.  Just as our farmers have been complaining of metal thefts, so have farmers in the Republic.  Therefore, it is clear that there have been difficulties there.  Mattie McGrath TD introduced a private Member's Bill in 2013, the Scrap and Precious Metal Dealers Bill.  There was criticism that it was too wide-ranging, dealing with gold and silver as well as scrap metal.  Although it was defeated in the Dáil, I noticed that Sinn Féin TDs there supported it, so I hope that its Members in the Assembly will likewise support my private Member's Bill in an attempt to regulate the industry.
Additional relevant new legislation has been introduced in the Dáil.  Following the defeat of that Bill, statutory instrument No 320/2014, Waste Management (Facility Permit and Registration) (Amendment) Regulations 2014, was approved on 11 July 2014, which amended the Waste Management (Facility Permit and Registration) Regulations 2007.  Licensed waste facilities would have to provide traceability of material purchased, documentation proving ID and proof of current address, for example a utility bill.  Last week, I contacted the Department of the Environment, Community and Local Government, and a senior official confirmed to me that the regulation was applicable to authorised scrap metal sites.  So, there already is a degree of traceability in the Republic of Ireland.
England and Wales have comprehensive scrap metal dealing.  What of Northern Ireland?  It is the absence of sufficient measures that has led me to develop this private Member's Bill.  So, when I approached the previous Environment Minister, I was advised that the Department of the Environment:
"does not have the vires to introduce the type of measure you refer to."
That measure being the Scrap Metal Dealers Act 2013.  The Minister agreed to examine how existing environmental law can be strengthened to address environmental crime.  I noticed that the Controlled Waste (Seizure of Property) Regulations (Northern Ireland) 2013 have been introduced.  Minister Attwood indicated in correspondence dated 26 March 2013:
"I agree in principle to the introduction of legislation which would regulate Scrap Metal Dealers as an industry".
However, he pointed out that the Home Office in England and the Justice Directorate in Scotland had responsibility.  Essentially, he would have liked the Justice Minister to deal with the legislation in Northern Ireland.  In recent correspondence dated 22 October 2015, since the publication of my Bill, there have been further changes requiring minimum operator competency, including metal recovery sites involving dry scrap.  The Minister is also currently consulting on a Waste Management Licensing (Amendment No. 2) Regulation 2015, although the consultation, I understand, has just recently closed.  So, there are other aspects afoot.
So, what of the Justice Minister?  When I approached the Department of Justice to ask the Minister if he was going to enact something similar to the scrap metal dealer legislation that existed successfully in England and Wales, he advised me in a letter dated 17 October 2012 that:
"I should advise you that this is an issue where the Department of the Environment is better placed to respond as currently, the Department of Justice does not have any locus over the regulation of the waste management industry in Northern Ireland."
He also pointed to the voluntary code of practice that was being adopted following Operation Tornado in England and Wales.  So, the Department of Justice and the Department of the Environment seem to be claiming that it was not their responsibility to legislate for scrap metal dealers.  So much for joined-up government.  It was at that point that I realised that there was a need for a private Member's Bill to try to bring about this change.
It is clear that there are aspects of the Bill that involve justice, and there are other aspects of the Bill that could be deemed to involve the Department of the Environment.  My Scrap Metal Dealers Bill would give the right of a constable to enter and inspect a scrap metal dealer's property at any reasonable time on notice to the site manager, and on other conditions for unannounced visits if necessary.  Indeed, the constable or, for that matter, the Department would be able to issue a closure notice where a scrap metal licence were not available and trading was occurring, and it would then have to apply for a court order to enforce it.
I notice that a number of Assembly Members have been pressing on this issue.  They, too, have obviously been experiencing difficulty in their areas.  I see a range of questions, from David McIlveen, Simon Hamilton, Adrian McQuillan and Judith Cochrane on the issue.  Just over a year ago, in May 2014, Karen McKevitt asked about the theft of metal manholes from the Department, and it turned out that 71 had been stolen in a 12-month period.  I notice that, in 2012, John Dallat asked about the cost of replacing manholes, and it was £35,500 in a 12-month period.  The cost of replacing electrical cable was £330,000.  I am also aware of considerable costs having built up for Translink.  At one stage, £145,000 of costs had been incurred.
I also noticed that, in a press release from February 2014 that was published on the BBC, NIE said that the theft of cables by people cutting down electrical poles in Newtownabbey that Tuesday was the seventh such incident that year.  This is very serious.  Criminals have been cutting down wooden live electricity poles using chainsaws.  Some of the cables may have been left over roads.  Someone at the end of the line who experienced disrupted supply may have needed an essential electricity supply for their medical condition.  These people, of course, had no consideration for that.
What has been happening in Northern Ireland without these powers?  I recently came across a publication on serious organised crime reported from illegal trade in stolen metal, and the Organised Crime Task Force annual report and threat assessment 2015 case study, on page 30, highlighted the problem of managing scrap metal dealers when relying solely on limited environmental legislation.  It went on to explain that, on 29 June 2010, Robert John Mulholland and Mulholland Scrap Metals Ltd were visited by Northern Ireland Environment Agency officers and a warning letter was issued asking for a cessation of scrap metal processing as no waste management licence was in force.  One year later, they visited again and noticed that the letter had been ignored.  During the investigation, it was estimated that 19,722 tons of scrap metal had been handled, with an estimated turnover of £3 million during the year.  Over three years later, in November 2014, at a hearing, the court imposed a confiscation order of £500,000 with a default period of five years' imprisonment if the site was not cleared within six months.  Whilst I welcome that significant court order against the illegal operation, I would point out that it took four and a half years for the court decision to come into being to force the closure of an illegal site.  I suggest that, if the Scrap Metal Dealers Bill were in place, a much speedier process would have brought that decision at an earlier time.
We have a voluntary scheme whereby most scrap metal dealers with sites record the details of who supplied the scrap metal; but not all dealers have adopted the scheme.  I was made aware that some large dealers did not follow the voluntary scheme and dealt with customers without any traceability.  Any could opt in or out of the scheme at any time.  There is no mandatory requirement.  Certainly, thinking back to the £3 million that I referred to earlier, if someone was content to trade on a large scale without any waste management licences and without any permissions, I do not think that they would volunteer to go into a non-mandatory scheme, and I doubt very much that they would be too concerned about who was depositing scrap metal material at an illegal site.  They certainly would not wish to create an audit trail of who was essentially dropping material off at an illegal site.
So it is clear that there are failings in our system.
In addition, mobile scrap metal dealers appear to be outside even the voluntary scheme, which is significant.  Where do mobile scrap metal dealers get their metal?  We have not got to the end of the supply chain.  Potentially, the PSNI cannot trace those who have been stealing metal, should that metal have been fed in through one of the many mobile scrap metal dealers.  The only records in the voluntary scheme will be at the main authorised sites, which voluntarily may have bought into the system.  My Bill would encompass mobile scrap metal dealers as well as the authorised sites.
Following invitations, I visited a couple of sizeable scrap metal dealer sites.  They already have significant systems to record details of those they are purchasing from.  Some even automatically take pictures of vehicles and the material that has been supplied.  This Bill would ensure that all would follow the good practice that is in the voluntary scheme and already in place for many.  There is a clear need for this Bill.  Furthermore, Northern Ireland is at risk of attracting scrap metal thieves who, in 2012 and 2013, moved regions and went to Scotland to benefit from weaker regulations elsewhere.  In addition, in 2014, the Republic of Ireland tightened its waste management regime, so we are even more open to stolen scrap metal entering the recycling system in Northern Ireland without a mandatory scheme ensuring traceability.
I undertook significant consultation in coming to the principles in my Bill.  I held a briefing session in Stormont as part of that process.  I had MLAs and interested parties along.  I was joined and supported by the Federation of Small Businesses and the Northern Ireland utilities group, which represents Northern Ireland Electricity, Northern Ireland Water, British Telecom and Translink — public bodies and service companies that have suffered considerable expense, disruption and loss of service as a result of the theft of metal.  I would like to put on record my appreciation for its encouragement and support, and in particular its coordinators, Sam Gibson of NIE and, now, George Ong of Northern Ireland Water.  I also invited the scrap metal industry to an information evening at Stormont where a briefing was given by Ian Hetherington of the British Metals Recycling Association who spoke of his experience of the GB legislation.  About 30 interested parties from across Northern Ireland attended.
The consultation was available in paper form as well as online.  A total of 66 responses were received, of which 55 were completed fully.  Seventy-five per cent of respondents thought that the current provisions for regulating scrap metals were inadequate; 75% thought that the voluntary code was not sufficient; and a massive 85% thought that additional legislation was required to combat metal theft.  Almost 82% thought that photographic ID should be required to prove identity when selling scrap metal to a dealer, and 85% agreed that vehicle registration should be recorded when selling.  I built those provisions into my Bill.
Concern was expressed about moving to a cashless system.  I listened to the consultation and built in an initial limit for going cashless of £100, and the provision to reduce that figure if agreed in future.  However, supplier details will have to be recorded to create traceability.  The Bill will allow the Minister to amend further and possibly go cashless at some point by using secondary legislation.
From the consultation and visits to scrap metal dealers, it was clear that the concept of a holding area to receive scrap metal would not be practical.  Therefore, I removed that idea from the Bill except in the very limited area of suspicious material — for example, burnt or defaced copper or aluminium cable — which I suggest should be held for inspection if found as part of a delivery.  The reason for that is that, in some parts of inner-city England, I saw where vacant office blocks had been stripped of all cables; the cables were literally taken outside and burnt to remove the plastic coating.  Part of the reason for that was to remove traceability so that the thieves could not be discovered, and it may increase the value of the metal as well, because it is then reduced to the raw metal.  Certainly, I would view it as a bad practice to allow that process to be adopted in Northern Ireland.  I suggest that where burnt metal is delivered — it would be a very small proportion of any precious metal, such as copper or aluminium cable — it should be set aside for a limited period and the police advised to allow it to be inspected and ultimately, potentially traced back to records showing who supplied that material to the dealer.  Hopefully, by doing that, the practice will be discouraged.
In addition to reduced bureaucracy for dealers — small dealers in particular — I propose that customer details in sales of less than 50 kilograms would not have to be recorded.  What does it matter to whom a second-hand door handle, car door or bonnet is sold?  The English system would require the small dealer to record that information and take the identification details of the person to whom he sells that item.  I view that as bureaucratic.  There is no harm in keeping a record of the bigger items.  In that way, if a car is stolen, at least the engine or gear box could not be sold that way in most instances and a degree of traceability is enabled.
The Department of the Environment is responsible for waste management licences for sites and monitoring of the transfer of waste material; it is also responsible for the maintenance of the environment and the prevention of pollution.  It seems to me better to have one Department dealing with scrap metal dealer licences than two.  In the English model, the Environment Agency has an interest in what is happening and also, potentially, the Ministry of Justice.  In my consultation, 72% of those who responded agreed that there would be less bureaucracy by having only one Department involved and, I suggest, lower costs.
There was clear support for higher fines for serious and repeat offences; even imprisonment was considered.
Whilst I had hoped to introduce these measures within a year of the Bill gaining support in the Assembly, I recognise that we need to move at an appropriate speed to allow the industry to retrain and put in place all the necessary bits and pieces.  In addition, over the next six months, Departments will be undergoing reorganisation, so I am open to allowing more time for introduction.
No concerns were expressed in the consultation about equality of opportunity or human rights implications.  If anything, responses were supportive.
As regards the cost implications of the Bill, we can minimise costs if one Department handles this along with the other waste issues that it handles.
I mentioned earlier the Organised Crime Task Force report.  There must be considerable costs, at present, in the bureaucratic, ineffective system that we have in taking a complaint to court and getting a judgement.  Can we not introduce legislation, such as this, to speed the process up and produce quicker results?  We have to remember that while illegal trading goes on, there will be costs to the environment.
Illegal traders will have scant regard for tracing where the material is from.  Who knows what the cost will be to the public.  I believe, therefore, that better legislation governing scrap metal dealers will bring savings to residential homes, businesses and churches — to a wide range of organisations — as well as potential savings to Departments that have to implement the legislation.
I have focused so far on the Environment Minister.  What about the Justice Minister?  Since its formation, the Department of Justice has faced huge challenges.  It has been heavily involved in legal aid reform and prison reform.  Scrap metal dealing has not been a priority.  There have been, I daresay, much bigger issues at which the Department has been directing its attention.  It has appeared to be relatively satisfied with the voluntary scheme, which, I acknowledge, has brought about improvements, and there has been a significant reduction in the theft of scrap metal in Northern Ireland.  I would highlight, however, that scrap metal theft is very closely related to the rewards that can be gained.
When I was researching this area, I came across a Home Office impact assessment of scrap metal theft in a document dated 22 February 2012.  In it there is a diagram compiled by the British Transport Police showing that the level of metal theft is closely related to, guess what, the value of the metal.  When the value of metal doubled, there was an increase in metal theft, because the rewards were greater and criminals were prepared to take greater risks.  Likewise, when there was a significant reduction in the value of copper, lead or other metal prices, there was a considerable reduction in the level of theft.  If you were to examine the current value of metals on the international market, you would see that there has been a steady decline from 2011-12.  In fact, copper and lead prices are approximately half what they were at that time.
Why I am saying this?  If we introduce legislation, I believe that we will be able to reduce metal theft even more in Northern Ireland, but, more importantly, we will protect ourselves when the price of metal increases again, when this will once more be a lucrative area for criminals to be involved in, because the risks and rewards are out of balance again.  I am saying to Members that we have been successful in driving down the level of metal thefts in Northern Ireland, but I urge Members not to be complacent.  If metal prices were to increase, we could expect the amount of theft to increase too.
I reiterate the point that whilst most scrap metal dealers in Northern Ireland have adopted the voluntary scheme, not all have, but the mobile scrap metal dealers, as far as I am aware, have not become involved in the scheme.  There is a grey area where there is the potential for abuse.
I illustrated that, in Great Britain, the roving crime gangs moved north into Scotland.  Indeed, in the Republic of Ireland, there were headlines about a Balkan gang flying in at the weekends to steal metal.  This involves international organised crime; it is not just about lead being stolen off somebody's roof.  There can be significant international criminal involvement.
In May 2015, at the Committee for Justice's stakeholder event on business crime, Wilfred Mitchell, from the Federation of Small Businesses, said:
"One area of rural crime that has been of concern to our members is metal theft."
At the same event, a representative of the Police Service of Northern Ireland indicated that there was ongoing concern and that:
"If it were a mandatory code of conduct, it would make it much harder for metal to be sold on."
— this is illegal metal that we are talking about —
"That means that it would be much easier to reduce the incidence of metal theft."
When I read that, it was clear to me that the PSNI could see the benefits of a mandatory scheme in helping to drive down crime.  That has certainly been the experience in England and Wales.
I wish to ensure that we do not face the future pain of being targeted when metal prices increase.  Cables supplying the public have been stolen; manhole covers have been stolen, leaving dangerous openings in our roads and on our footpaths; and buildings have been destroyed by the removal of lead flashing and corporate pipes.  I therefore argue that there is an urgent need for the legislation.
Daniel Greenberg, the experienced legislative draftsman, said that every piece of legislation, however apparently technical:
"impacts on someone's life:  and Assembly Members are directly responsible for authorising the interference.  They cannot give that authority without being satisfied that the legislation is the best form reasonably possible to achieve the stated purpose, and that the purpose justifies the intrusion into people's lives and constraints on their liberty."
In bringing the Bill forward, I have attempted to follow those principles.
I hope that Members agree that there is a need for the legislation and that I have included some protection to minimise bureaucracy.  I hope that Members will support me and join me on a journey to scrutinise the legislation to ensure that we can make it the best legislation possible to protect our community, our homes and our businesses against the future risk of metal theft so that all will be able to live in Northern Ireland without the unwanted interference of criminals who disrupt lives and businesses.  I ask for Members' support.

Pam Cameron: I commend Mr Beggs for his work so far and for bringing the Scrap Metal Dealers Bill before the Assembly this evening.  The Bill is a good example of how the Assembly can seek to resolve an issue that may not be particularly high-profile but nevertheless impacts greatly on those who are unfortunate enough to be the victim of crimes involving scrap metal theft.  We heard much about that from the Member this evening.  I support the principles of the Bill, and its drafting appears to have satisfactorily covered most of the main issues.  I will therefore keep my remarks brief.
I am aware that there have been differing opinions on which Department should lead on the subject: whether it should come under the Department of Justice, as it is about metal theft, or the Department of the Environment, given the licensing element to the Bill.  I can see the argument on both sides.  I asked Mr Beggs, when he came before the Environment Committee, whether an Ad Hoc Joint Committee might be necessary, and he did not rule that out.  What is important is that, whatever Department takes responsibility, full scrutiny of the Bill take place, assuming that the Bill passes its Second Stage.  It is disappointing to see that we do not have a Minister here to answer that tonight, so we still do not know where it will sit.
As far as the Department of Justice is concerned in its dealings with scrap metal theft, it is clear that the current scheme that it operates, whereby there is only a voluntary arrangement in place, is not sufficient to prevent or deter the current levels of criminality.  I note that, as far back as September 2012, the Northern Ireland Environment Agency's environmental crime unit came before the Committee and expressed concern that the existing measures to reduce and combat the high levels of metal theft in Northern Ireland were not effective.  It is clear from statistics received since then that it was right to be concerned.  I trust that the Bill will address those concerns in a much more comprehensive way.
I recognise, of course, that there will be many concerns from scrap metal dealers, not least over the idea of moving towards a cashless system.  Again, trusting that the Bill passes its Second Stage, the Committee will hear all those concerns in the near future.  I support the general principles of the Bill.

Cathal Boylan: Go raibh maith agat, a Phríomh-LeasCheann Comhairle.  Ba mhaith liom cúpla focal a rá.
I would like to say a few words in relation to the Bill.
I commend the Member for bringing the Bill to the Floor and for the work that he has done thus far.  I can give him some reassurance that his Bill is certainly not going to be scrapped tonight by Sinn Féin, but I have some issues with it.  I know that the Member brought the Bill to the Committee last Tuesday; unfortunately, I could not stay for the whole presentation.  I certainly hope that the Member's intention with the Bill is to work with and protect the industry as much as to prevent an outlet for criminals.  I hope that that is the full intention of the Member's Bill, because that is important.
At the inception of the Member's Bill away back in 2013, theft and crime in relation to copper, lead and other metals were prevalent.  I think that has now dropped, but there is an opportunity to address it.  I have had time to speak to some businesses over the weekend that shared some concerns about what the Member proposes.  They believed that the voluntary scheme that they were working on was sufficient, but I see from some of the consultation that the Member carried out that a majority of consultees are in favour of legislation.
I just want to mention to the Member — I brought it up the last time, and the Member will know this already — that I know of some people who work in the construction industry, like plumbers and electricians, who, on occasion, collect small cuttings of copper wire: can the Member indicate to me whether those people, who might collect it or once or twice a year and bring a small amount of copper wire or piping to a scrap metal dealer, would require a collector's licence?  In his winding up, maybe the Member can explain that to me.  If we were down to that level, I would ask for consideration of exemptions in the Bill.
I am not too sure whether the Bill is going to the Environment Committee or the Justice Committee. What he is trying to do on the introduction of licensing may sit with DOE, but, ultimately, it is about organised crime and theft. That is a criminal issue, so you could argue that it lies within the justice system.  It will be interesting to see who ends up with it.  The Member who spoke previously mentioned an Ad Hoc Committee: that might be the way to go forward with thorough scrutiny in Committee.
I do not propose to keep Members back tonight after a long session on the previous Bill, but maybe in his summing up the Member could indicate the costings of all of this in terms of licences and the cost to businesses.  Also, on the issue of verification under clause 9, there is talk about photographic ID and the taking of information.  I go back to my original point about a single operator going once a year or twice a year: it would be extreme for them to have to provide that information.
Also, in relation to cash transactions, the Member has specified £100 in that provision of the Bill.  I just wonder if there is some scope, through an amendment, to increase that.  I am just saying that in line with what I have indicated about the people who may visit the scrap metaller just to offload some cuttings.  Basically, that is about all that I would like to say on the Bill.
Sorry, I have one other point, through you, Mr Principal Deputy Speaker.  It is the issue of enforcement and the constable being able to go on site at any point to check.  Will the Member elaborate a wee bit more on how that would work?  Will he confirm whether the constable is part of the justice system or is a member of an enforcement team in DOE?  Maybe we could get some clarity on how he proposes that would work out.  Maybe it is down for discussion in Committee or during another phase of the Bill.
The Bill should regulate scrap metal dealers and effectively remove the outlet for criminals whilst not creating more red tape for business owners and undue burdens on the industry. Sin a bhfuil le rá agam.  That is all that I have to say for now.  I am content to let the Bill go through at this stage.  I will support it.

Alban Maginness: We are dealing with the general principles of the Bill today, and my party and I support its general principles.  The principal objective of the Bill is to combat the trade of illegally obtained metal in Northern Ireland, particularly high-value metal such as copper and aluminium.  The Bill seeks to do that by licensing the carrying on of scrap metal dealing businesses and certain aspects of the sale and purchase of metal in Northern Ireland. It is clear that there has been significant cost and disruption to private individuals, churches, schools and public and private bodies as a result of stolen metal.  At present, there is no legislative requirement for those dealing in scrap metal to provide an audit trail and reduce the ease with which stolen property is traded.
The Bill's origins arise from the significant levels of theft of lead and copper in Belfast, the greater Belfast area and Northern Ireland in general.  Metal is sometimes stolen as manhole covers and, at other times, from electricity substations and is then sold on by organised criminal gangs to scrap metal dealers.  All those crimes have an immediate consequence for the public whether it is disruption to a service or the public cost of replacing the material. The illegal trade and sale of metal remains a lucrative business, and it is crucial that Northern Ireland has robust regulations that are able to tackle those crimes through targeting and through the regulation of scrap metal dealers.
The Bill seeks to provide new provisions for the further regulation of scrap dealers in Northern Ireland and to directly tackle the stealing and sale of metal.  We must all support that.  The Bill also aims to reduce the effect of thefts on victims and to protect resources overall.  The Bill seeks to licence scrap metal businesses and regulate aspects of the sale and purchase of the metal.
There is a public concern and interest in more robust regulation in this area.  My party has been clear that we are concerned about the rise in the theft of metal for sale.  We believe that it is essential that organised criminal organisations no longer profit from these acts. The PSNI report 'Metal Theft in Northern Ireland: Quarterly Update to 31st March 2013' recorded that nearly 300 crimes of burglary, robbery and theft were related to metal. In 2015, an update on metal theft in Northern Ireland revealed that, this year, we have had 552 burglaries, robberies and offences relating to metal.  Copper remains the most common metal, followed by lead. While the theft figures are still a cause for concern, they are something that we must deal with at source.  In Mr Beggs's consultation, 75% of respondents believed that the current legislation was not adequate in detecting the trade in stolen metal. Another 75% believed that the voluntary code of guidance was not sufficient in dealing with metal theft, while 85% agreed that legislation was indeed necessary to combat the problem.
There is an issue, however, that has been raised by two Members, and that is that there is a departmental conflict over the Bill.  The central issue of the Bill appears to be whose legislative remit it actually falls under — the Department of the Environment or the Department of Justice.  Mr Beggs, as I understand it, believes that the Department of the Environment should be responsible for implementing the Bill, as scrap dealers are regulated under waste legislation; however, the DOE believes that the primary purpose of the Bill is the prevention of non-environmental crime and that it is not for the Department to deal with directly. I believe that the current waste framework directive intention is to protect the environment and the population's health in relation to the environment.  Metal theft, upsetting or damaging as it is, does not really fall under this, as it is a crime of material.  I suspect that, if the Bill falls into the DOE remit, the Department will need a serious investment of funds from the Executive in order to gain competency in criminal action and the tracking of financial mismanagement.  That would provide an extra burden on the Department in dealing with something that is a non-environmental issue.  It would be easier to leave the issue under Justice, which, through the PSNI and other relevant agencies, has the skills and knowledge required.  Both sides have, indeed, compelling arguments, but I am of the opinion that, as the central purpose and principle of the Bill, as I stated earlier, is tackling metal theft crime, the implication of the legislation in dealing with that would naturally make it a Department of Justice issue. Further to that, I note that the legislation, in the form of the Scrap Metal Dealers Act 2013, in England was prepared by the Home Office and passed at Westminster, whereas, in Scotland, the Scottish Justice Directorate dealt with the legislation, not the equivalent Department of the Environment.  Therefore, I argue that a precedent has been set by other legislatures, and the Northern Ireland Department of Justice — the body with the greatest equivalence to the Westminster and Scottish sponsoring Departments — is best placed to prepare the Bill.
At any rate, the implementation of the Bill and the reduction of metal crime will be greatly assisted by the joint efforts of the DOJ, DOE, PSNI and all related agencies working together after the completion of the Bill.  I support the principle of the Bill, but I have to indicate that my party and I have reservations as to how it should be implemented.  I wait for the authorities in the House to decide on the allocation of the Bill.  I am not sure who will make the decision.  I understood that it would be the Business Committee.  I have asked members of the Business Committee, but they seem to say, "Well, it's not really our responsibility.  It it is a matter for the Executive to make a decision in relation to who deals with the Bill". I wait with interest and some curiosity to see who will make the decision and to what Department the Bill will fall.

Anna Lo: I welcome the opportunity to contribute to today's Second Stage debate as the Alliance Party's MLA for South Belfast.  We support the principles of the Bill.
As Mr Beggs outlined, the purpose of the Bill is to license scrap metal dealers to carry out their business, to combat the trade of illegally obtained metal, to reduce the impact on victims of scrap metal crime, and to safeguard valuable resources for individuals and organisations.  The Bill proposes to establish the Department of the Environment as the issuing body of the licence, whilst providing the PSNI with the right to enter and inspect the premises of licensed scrap metal dealers.
Clearly, there are cross-cutting issues that are relevant for both the DOE and the Department of Justice.  As others have mentioned, as yet no Department has taken the lead in the Bill, although Mr Beggs argued that, given that DOE already issues licences to scrap metal dealers as part of the waste management licensing regime, it sits well with DOE to regulate that activity.  He also argued that, with DOE issuing the licence and by linking it to existing regulations, there will be resulting efficiencies for Government and the industry.
Metal theft is not a victimless crime; it can cause great distress and expense to those who experience it.  Over the years, I have seen numerous metal thefts in my constituency, such as people climbing onto roofs to steal lead flashing, which can cause damage to the roof as it loosens the slates and results in internal damage through rainwater getting in.  There have also been incidents in south Belfast of criminals taking copper piping from vacant social housing properties, thereby causing flooding.  That happened in the Village during the regeneration of the area and caused considerable problems.  In February 2014, copper piping was stolen from a property in Camden Street, which led to a gas leak.  That is not just a petty crime; it causes considerable damage and safety risks.  I certainly agree that there is a need for more action, and, therefore, I welcome the Bill.
In England and Scotland, legislation is already in place, and the Republic of Ireland has also made similar provisions.  We risk the displacement of those crimes to Northern Ireland if we are the only region not to have legislation on this.  We need a concerted and coordinated effort from neighbouring countries to drive out those crimes.
Cashless dealings in England have proven to be effective.  I understand that, in Northern Ireland, all transactions are done by cash.  That means that there is no audit trail of financial dealings.  Similarly, requiring identification for those who supply scrap metal would provide traceability if theft were to be investigated by the police.
It is unfortunate that the Bill has come to the House so late.  It is so near the end of the mandate that it may not provide sufficient time for scrutiny by whichever Committee it is assigned to.  My party's position is that the Bill is better placed in the Department of the Environment, given that the operations of scrap metal dealers and other waste issues fall under the DOE as set out in the 2013 waste management strategy.  The Bill is about the regulation of metal recycling facilities, and recycling is done for environmental reasons, which adds further weight for this being a DOE matter.  If we look at England and Wales, it is the role of the local authority to lead on this.  As we know, DOE is the Department that is responsible for local government.  While there is undeniably a justice aspect to the Bill, especially in the case of prosecution, DOE should certainly collaborate.  The Alliance Party is of the opinion that the Bill should be assigned to the Department of the Environment.

Paul Girvan: I congratulate Mr Beggs on bringing forward this private Member's Bill on dealing with the scrap metal industry.
I am not going to keep everybody very late, because I appreciate that hot potatoes seem to be on people's minds.  This seems to be a bit of a hot potato for the two previous Members to speak, with one defending his Environment Minister's not wishing to take the Bill on and the other defending the Justice Minister's not wishing to take it on.  We will just work our way around that.
This is an issue on which there is great interest, and it needs to be grasped and dealt with.  Unfortunately, the criminal elements will always find a way of ensuring that they do not abide by whatever process exists.  The voluntary system of registration and ensuring that records are held has obviously proven unworkable in its management.  So, a mandatory approach is a necessity for ensuring that that happens.  That would be of benefit and would give some form of traceability.
I want to make sure that the criminal elements who want to remove lead and copper from buildings receive the full penalties and cannot get rid of the items.  That is where the problems arise:  if they have a market, they will obviously be willing to engage in such criminal activity.  As a consequence, it is vital that we do all within our power to ensure that there is some mechanism for accountability and traceability within an industry that has not had a great press.  Putting forward a legal approach in a Bill is probably the way to do that.
I appreciate that one of the mechanisms concerns dealing with cash.  Some people say that everything should be dealt with by plastic, but it is nice to have some money in your pocket and know what you are spending.  If you work with plastic, you will not know what you have spent:  if you start off in the morning with £20 in your pocket and you spend a few pounds, you know what you are left with at the end of the night.  Unfortunately, you sometimes spend more when you are using plastic.  A cashless society is not necessarily the route I want to go down.
There is major engagement on this.  At the Committee Stage, we can tease out a number of concerns we have.  We have to encourage those in the industry who have been good custodians and have voluntarily entered into the agreement.  The views of those people have to be taken into account.  There are those who have excluded themselves from registration, and they probably need more attention.
Mention was made of those who are mobile scrap merchants.  There are many other things that can be termed as "mobile", and I do not want to go too far into that, but there are a number of criminal elements who only want to be "mobile".  We need to put legislation in place.
I am happy to support the Bill's passage from Second Stage to the Committee Stage for scrutiny.  There is work that needs to be done.  We have reservations about some areas of the Bill, and I think we can come forward with something that will be workable.

Ian Milne: Go raibh maith agat, a Phríomh-LeasCheann Comhairle.  At this stage, it has all been said, but, for the record, I will carry on with what I have here.
We have only recently been given this Bill.  I thank Mr Beggs for the presentation that he made to the Committee on Tuesday.  He was very thorough in his rationale for bringing forward this private Member's Bill.  I do not think that anyone objects to the broad principle; that is certainly what I have heard tonight, anyway.
However, there are many questions still to be answered, not least about where the legislation belongs.  This is repetitive of what has been said tonight.  In England, it was dealt with through the Home Office.  In Scotland, it was through the Justice Department.  In the South of Ireland, a similar Bill, although unsuccessful, was also brought through the Justice Department.  The reason, as has already been said, is that the main focus appears to be on tackling organised crime and increasing the powers of the enforcers, whether it is the PSNI or whoever, for the scrap metal industry.  I accept that the DOE would have some role to play in terms of waste management and licensing, but, beyond that, everything else points to the Justice Department.  If it is to proceed, consideration may need to be given to an Ad Hoc Committee, as was stated earlier this evening.
Additionally, any change to legislation needs to be harmonised with the Twenty-six Counties.  Otherwise, it will do nothing to put off those involved in that type of activity; they will simply move their operation South of the border.  It will serve no purpose at all.  That is evidenced by the Scottish example after England and Wales enacted the Scrap Metals Dealers Act 2013.
Scrutiny of the Bill will fall to the Department determined by the Business Committee or whoever, as the Member to my left said, but at this stage, wherever it goes, bureaucracy needs to kept to a minimum.  Care must be taken to ensure that the customer's interaction at the scrapyard does not become so difficult or intrusive that the genuine customer is put off or is so expensive that the small dealer is put out of business.
I support the broad principles of the Bill.

Roy Beggs: I thank all the Members who contributed to this discussion and have indicated their support for the principles of the Bill.
Pam Cameron suggested an Ad Hoc Committee or joint Committee to deal with it.  I understand that the Business Committee will decide what the future model will be, assuming that we continue through this process.  It appears that we will today.  I hope that Members will, ultimately, vote for it.
Cathal Boylan wanted to know about ensuring that we would not over-regulate the industry.  He wanted to look at costs that would flow from it.  That has been quite central to my thinking.  It is for that reason that I put in some weight exemptions to enable cashless transactions to occur up to a certain level.  He asked about what would happen to the plumber and the electrician.  I will be seeking advice from a lawyer.  It was a draftsman who ultimately came up with the wording.  Ultimately, a court or judge would finalise it.  I suggest that, if there had not been any transaction in obtaining the bits and pieces by a tradesman, he would not be trading.  If he had the items and some form of reward was given in exchange, I would have thought that that would be some form of transaction.  I accept that it is certainly an area that needs to be clarified.  It would be important that those working under it understand the rules.
The cost of a licence will be determined by the amount of bureaucracy that we build into the system.  One of the issues that I have highlighted is this:  will we require two sets of civil servants to examine this legislation as it goes through?  If there were an application for a new licence, will there be two groups of people going out to look at a site?
One of my aims has been to try to reduce costs by minimising any sort of bureaucracy.  He also enquired about the power of a constable to close a site down.  That appears under a provision on dealing with unlicensed sites.  If a site is clearly unlicensed, he would have the power to close it down.  We are not talking about authorised sites; we are talking about unlicensed sites in that regard.
Alban Maginness supported the general principles of the Bill.  I thank him for that.  He highlighted the issue of the departmental conflict.  That has been a problem from the beginning.  Paul Girvan said that it was a bit of a hot potato.  He talked about how everybody seemed to agree that it was a good idea but did not want to take it on board.  He said that there was a feeling that somebody else should deal with it.
All I have to say to that is that the criminal does not care which Minister deals with it; the constituent whose lead flashing gets stolen or whose copper pipes get ripped out does not care which Minister deals with it.  Where is our joined-up government?  We need it dealt with, and dealt with efficiently.  Let us not have a fight over whose Department is responsible for it.  It is important that it is dealt with.
I am sure that, ultimately, both Departments will be required to interact, because there are issues involving justice and the environment, but we are not having to reinvent the wheel.  Luckily, experienced draftsmen have already crafted the legislation in England and Wales and, indeed, Scotland.  We just need to refine that to make it applicable to our situation.  There is some good wording out there to base it on.
Anna Lo highlighted the theft of lead and copper, and the issues that she is aware of in her constituency.  She mentioned an issue that I have not come across — how a gas leak had resulted from metal theft.  So, it is not just a petty crime; major dangers can be caused to the public as a result of metal theft.  This issue needs to be dealt with appropriately and with a degree of urgency, because it has taken too long already.
As I have said, legislation exists in other parts of the United Kingdom and, indeed, a traceability system is in existence in the Republic of Ireland.  Interestingly, she mentioned the fact that local authorities can have a role in England and Wales.  With the reform of local government, perhaps there will be a review and a need for the involvement of local councils.  Certainly, it is they who will have environmental officers on the ground in each area.  I am open to that issue being taken forward.  There certainly needs to be collaboration with the Justice Department and the Environment Department, as I said earlier in response to Paul Girvan's comment on it being a hot potato.
Ian Milne indicated his broad support, but he was concerned about the cross-border aspect.  As I have explained, there is already a requirement for the audit and traceability of material being purchased at licensed dealers' sites in the Republic of Ireland, so it is us who are open for abuse at present, with material coming the other direction.  Certainly, I agree with him that we need to keep bureaucracy to a minimum.  When we look at this, we should not be arguing over the Department of the Environment or the Department of Justice.  We have to look at the end consumer, the user and the businesses that will have to operate under the legislation, and we should be designing it to meet their needs, not those of civil servants who may have a particular specialism in the area.  Certainly, their advice is needed to ensure that the legislation is got right, but we should be looking to the outworkings of the legislation to ensure that its costs are kept to a minimum and that it is able to do what it sets out to achieve.
One of the most telling aspects of this debate on the Bill is the empty ministerial chair.
That really does show the lack of joined-up government that we have had to date.  I highlighted this issue several years ago in a question on the Programme for Government.  I was referred to individual Departments.  It is such a pity that this was not built into the Programme for Government at some stage, even belatedly, in order to recognise that, even though it is cross-departmental, there is a gap and that joined-up government should bring it forward.
I am pleased to have received general support for the principles of the Bill at this stage.  I look forward to further scrutiny and to working with the Committee, whatever Committee is deemed to be appropriate to deal with it, to try to make sure that we deliver legislation which meets the needs of our constituents and minimises the disruption that could occur in their lives as a result of metal theft.
Notice taken that 10 Members were not present.

House counted, and, there being fewer than 10 Members present, the Principal Deputy Speaker ordered the Division Bells to be rung.

Upon 10 Members being present —
Question put and agreed to.

Resolved:
That the Second Stage of the Scrap Metal Dealers Bill [NIA 65/11-16] be agreed.

Robin Newton: That concludes the Second Stage of the Scrap Metal Dealers Bill.
Adjourned at 8.51 pm.